Provider Demographics
NPI:1689025116
Name:NEW SCHRYVER LLC
Entity Type:Organization
Organization Name:NEW SCHRYVER LLC
Other - Org Name:TRIDENTCARE
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 1:930 RIDGEBROOK RD FL 3
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9481
Mailing Address - Country:US
Mailing Address - Phone:800-786-8015
Mailing Address - Fax:
Practice Address - Street 1:3414 MIDCOURT RD STE 112
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5092
Practice Address - Country:US
Practice Address - Phone:800-638-3240
Practice Address - Fax:443-842-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3634727-01Medicaid
MN1689025116Medicaid
OR500782022Medicaid
OK200675620BMedicaid
CA1689025116Medicaid
AL191102Medicaid
MS5270351Medicaid
NM92727514Medicaid