Provider Demographics
NPI:1518090448
Name:ATHEROTECH, INC.
Entity Type:Organization
Organization Name:ATHEROTECH, INC.
Other - Org Name:ATHEROTECH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUSIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-314-7506
Mailing Address - Street 1:201 LONDON PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-4498
Mailing Address - Country:US
Mailing Address - Phone:800-719-9807
Mailing Address - Fax:205-314-7404
Practice Address - Street 1:201 LONDON PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-4498
Practice Address - Country:US
Practice Address - Phone:800-719-9807
Practice Address - Fax:205-314-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL01D0641541291U00000X
AL7587-L3733291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000007816OtherBCBS PROVIDER NUMBER
AL000007816Medicaid
AL000007816Medicaid
AL000007816Medicare ID - Type UnspecifiedMEDICARE PROVIDER #