Provider Demographics
NPI:1679228191
Name:CAPTURE DIAGNOSTICS, HIB01 LLC
Entity Type:Organization
Organization Name:CAPTURE DIAGNOSTICS, HIB01 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-576-1904
Mailing Address - Street 1:1330 KINNEAR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1166
Mailing Address - Country:US
Mailing Address - Phone:702-576-1904
Mailing Address - Fax:
Practice Address - Street 1:1950 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3453
Practice Address - Country:US
Practice Address - Phone:855-855-6407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPTURE COLLECTIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-14
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory