Provider Demographics
NPI:1669539243
Name:MACHAON DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:MACHAON DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:PENFIELD
Authorized Official - Last Name:ERO
Authorized Official - Suffix:
Authorized Official - Credentials:MT, CLS
Authorized Official - Phone:510-839-5600
Mailing Address - Street 1:2023 EIGHTH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2026
Mailing Address - Country:US
Mailing Address - Phone:510-839-5600
Mailing Address - Fax:510-839-6153
Practice Address - Street 1:2023 EIGHTH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2026
Practice Address - Country:US
Practice Address - Phone:510-839-5600
Practice Address - Fax:510-839-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1019489291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY10410Medicare UPIN
CAZZZ29461ZMedicare ID - Type Unspecified