Provider Demographics
NPI:1760787758
Name:NORTHERN TIER RESEARCH
Entity Type:Organization
Organization Name:NORTHERN TIER RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:COYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-282-4340
Mailing Address - Street 1:1300 OLD PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1973
Mailing Address - Country:US
Mailing Address - Phone:570-282-4340
Mailing Address - Fax:
Practice Address - Street 1:1300 OLD PLANK RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:PA
Practice Address - Zip Code:18433-1973
Practice Address - Country:US
Practice Address - Phone:570-282-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN TIER RESEARCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D1050690291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory