Provider Demographics
NPI:1740248848
Name:SIGNATURE GENOMIC LABORATORIES, LLC
Entity type:Organization
Organization Name:SIGNATURE GENOMIC LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEJJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-474-6840
Mailing Address - Street 1:PO BOX 4474
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-0474
Mailing Address - Country:US
Mailing Address - Phone:509-474-6840
Mailing Address - Fax:509-474-6839
Practice Address - Street 1:2820 N ASTOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2112
Practice Address - Country:US
Practice Address - Phone:509-474-6840
Practice Address - Fax:509-474-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS4427291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG81357Medicare UPIN