Provider Demographics
NPI:1659641645
Name:NEOGENOMICS LABORATORIES INC
Entity Type:Organization
Organization Name:NEOGENOMICS LABORATORIES INC
Other - Org Name:CLARIENT DIAGNOSTIC SERVICES, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP & PRINCIPAL ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-776-5907
Mailing Address - Street 1:31 COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1460
Mailing Address - Country:US
Mailing Address - Phone:866-776-5907
Mailing Address - Fax:888-443-4153
Practice Address - Street 1:6455 MISSION
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324
Practice Address - Country:US
Practice Address - Phone:866-766-5907
Practice Address - Fax:888-443-4153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOGENOMICS LABORATORIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
23D2013964OtherMEDICARE CLIA
MI23D2013964OtherCLIA