Provider Demographics
NPI:1851769020
Name:AFFINICORP LLC
Entity Type:Organization
Organization Name:AFFINICORP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-202-9400
Mailing Address - Street 1:2307 RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-5001
Mailing Address - Country:US
Mailing Address - Phone:502-290-8728
Mailing Address - Fax:502-849-0455
Practice Address - Street 1:2307 RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-5001
Practice Address - Country:US
Practice Address - Phone:502-290-8728
Practice Address - Fax:502-849-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory