Provider Demographics
NPI:1851773683
Name:AMPLIFY XY, LLC
Entity Type:Organization
Organization Name:AMPLIFY XY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LASECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-289-8442
Mailing Address - Street 1:265 WARWICK CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8543
Mailing Address - Country:US
Mailing Address - Phone:330-289-8442
Mailing Address - Fax:
Practice Address - Street 1:265 WARWICK CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8543
Practice Address - Country:US
Practice Address - Phone:330-289-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory