Provider Demographics
NPI:1790068088
Name:SPECIMEN COLLECTION SERVICES LLC
Entity Type:Organization
Organization Name:SPECIMEN COLLECTION SERVICES LLC
Other - Org Name:SPECIMEN COLLECTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:302-561-1166
Mailing Address - Street 1:64 W KYLA MARIE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:64 W KYLA MARIE DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5432
Practice Address - Country:US
Practice Address - Phone:302-561-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health