Provider Demographics
NPI:1710253596
Name:PACIFIC EDGE DIAGNOSTICS USA LTD.
Entity Type:Organization
Organization Name:PACIFIC EDGE DIAGNOSTICS USA LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-220-7005
Mailing Address - Street 1:1214 RESEARCH BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9196
Mailing Address - Country:US
Mailing Address - Phone:717-220-7005
Mailing Address - Fax:717-220-7006
Practice Address - Street 1:1214 RESEARCH BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9196
Practice Address - Country:US
Practice Address - Phone:717-220-7005
Practice Address - Fax:717-220-7006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC EDGE LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory