Provider Demographics
NPI:1528364056
Name:MITOMICS (USA) INC.
Entity Type:Organization
Organization Name:MITOMICS (USA) INC.
Other - Org Name:MITOMICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DULUDE
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:807-472-0303
Mailing Address - Street 1:290 MUNRO STREET
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:THUNDER BAY
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:P7B7B6
Mailing Address - Country:CA
Mailing Address - Phone:807-768-4513
Mailing Address - Fax:807-768-4519
Practice Address - Street 1:12635 E MONTVIEW BLVD
Practice Address - Street 2:ROOM 100G
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7335
Practice Address - Country:US
Practice Address - Phone:720-859-3540
Practice Address - Fax:720-859-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory