Sequenom Center for Molecular Medicine LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC

Doing business as

Sequenom Laboratories

Practice address

301 Michigan St NE Ste 580
Grand Rapids, MI 49503-3314

Phone

(858) 202-9051

Fax

(858) 408-7847

NPI assigned

Jan 21, 2009

Organization subpart

Yes

Parent organization

SEQUENOM INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dirk Van Den Boom, PHD

Title

President

Phone

(858) 202-9051

Specialties & licenses 1

Addresses

Other names 1

• Sequenom Laboratories Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1528205028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 JOHN HOPKINS CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211121",
            "telephone_number": "858-202-9051",
            "fax_number": "858-408-7847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MICHIGAN ST NE STE 580",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033314",
            "telephone_number": "858-202-9051",
            "fax_number": "858-408-7847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEQUENOM INC",
        "enumeration_date": "2009-01-21",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "VAN DEN BOOM",
        "authorized_official_first_name": "DIRK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-202-9051",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sequenom Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.