Provider Demographics
NPI:1407060411
Name:CELLNETIX LABS, LLC
Entity Type:Organization
Organization Name:CELLNETIX LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-576-6138
Mailing Address - Street 1:1124 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2026
Mailing Address - Country:US
Mailing Address - Phone:206-576-6138
Mailing Address - Fax:206-215-6090
Practice Address - Street 1:12501 E MARGINAL WAY S STE 200
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-2560
Practice Address - Country:US
Practice Address - Phone:206-576-6138
Practice Address - Fax:206-215-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D1067441291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D1067441OtherCLIA #
WA7138043Medicaid
WAMTS-5084OtherMEDICAL TEST SITE
WAP00265479Medicare PIN
WAG8866903Medicare PIN