Provider Demographics
NPI:1255796686
Name:ARCHER MEDICAL DIAGNOSTIC TESTING
Entity type:Organization
Organization Name:ARCHER MEDICAL DIAGNOSTIC TESTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-455-9178
Mailing Address - Street 1:3799 COMMERCE CT STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2027
Mailing Address - Country:US
Mailing Address - Phone:716-205-0433
Mailing Address - Fax:716-706-1416
Practice Address - Street 1:3799 COMMERCE CT STE 300
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2027
Practice Address - Country:US
Practice Address - Phone:716-205-0433
Practice Address - Fax:716-706-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory