Provider Demographics
NPI:1942226006
Name:SYSTEM COORDINATED SERVICES, INC
Entity Type:Organization
Organization Name:SYSTEM COORDINATED SERVICES, INC
Other - Org Name:LIFE LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4396
Mailing Address - Street 1:299 CAREW STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109
Mailing Address - Country:US
Mailing Address - Phone:413-748-9500
Mailing Address - Fax:413-732-3349
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-748-9500
Practice Address - Fax:413-732-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2303291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0805157Medicaid
228379Medicare ID - Type Unspecified