Provider Demographics
NPI:1659669430
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:PROVIDER RELATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-307-2081
Mailing Address - Street 1:12075 E 45TH AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3123
Mailing Address - Country:US
Mailing Address - Phone:303-371-0073
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2070049Medicaid