Provider Demographics
NPI:1255781639
Name:BIOTRINETIX
Entity type:Organization
Organization Name:BIOTRINETIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-299-5411
Mailing Address - Street 1:1020 HOLLAND DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5717
Mailing Address - Country:US
Mailing Address - Phone:207-299-5411
Mailing Address - Fax:
Practice Address - Street 1:1020 HOLLAND DR
Practice Address - Street 2:SUITE 115
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-5717
Practice Address - Country:US
Practice Address - Phone:207-299-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18197291U00000X
FL80028108291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory