Provider Demographics
NPI:1659523967
Name:NEW SCHRYVER LLC
Entity Type:Organization
Organization Name:NEW SCHRYVER LLC
Other - Org Name:TRIDENTCARE LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-786-8015
Mailing Address - Street 1:12075 E 45TH AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3136
Mailing Address - Country:US
Mailing Address - Phone:303-371-0073
Mailing Address - Fax:303-785-9333
Practice Address - Street 1:12668 INTERURBAN AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3314
Practice Address - Country:US
Practice Address - Phone:303-371-0073
Practice Address - Fax:443-842-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D1088804291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006575Medicaid
OR500620752Medicaid