Provider Demographics
NPI:1881791671
Name:ACCUMOLECULAR DIAGNOSTICS
Entity type:Organization
Organization Name:ACCUMOLECULAR DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:U
Authorized Official - Last Name:MICHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:210-473-4729
Mailing Address - Street 1:2140 BABCOCK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4400
Mailing Address - Country:US
Mailing Address - Phone:210-473-4729
Mailing Address - Fax:210-579-6582
Practice Address - Street 1:2140 BABCOCK RD STE 220
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4400
Practice Address - Country:US
Practice Address - Phone:210-473-4729
Practice Address - Fax:210-579-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN NUMBER
TX=========OtherEIN NUMBER