Organization Active NPI

Sequenom Center for Molecular Medicine LLC

Doing business as Sequenom Laboratories

Clinical Medical Laboratory
Morrisville, NC

National Provider Identifier

1639426281

Registry record updated Mar 30, 2016

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Morrisville, NC
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Medical LaboratoryTaxonomy code 291U00000X
License: 34D2044309 Issued in NC
Legal business name: SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC
Doing business as: Sequenom Laboratories
Practice address: 7010 Kit Creek Rd
(Physical Only - No Usps Mail Delivery)
Morrisville, NC 27560-9761
Phone: (858) 202-9051
Fax: (858) 408-7847
NPI assigned: Aug 13, 2012
Last updated: Mar 30, 2016By the provider in NPPES
Organization subpart: Yes
Parent organization: SEQUENOM INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name: Dirk Van Den Boom, PHD
Title: President
Phone: (858) 202-9051

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Clinical Medical Laboratory	291U00000X	34D2044309	NC	Primary

Addresses

Primary practice location

7010 Kit Creek Rd
(Physical Only - No Usps Mail Delivery)
Morrisville, NC 27560-9761

Mailing address

3595 John Hopkins CT
San Diego, CA 92121-1121
Phone (858) 202-9051

Other identifiers 43

Identifier	Type	State	Issuer
1639426281	Medicaid	MI
1639426281	Medicaid	IA
468862	Medicaid	AZ
L00366	Medicaid	SC
LCO000772	Other	RI	STATE OF RHODE ISLAND, DOH OFFICE OF FACILITIES REGULATION, LAB LICENSE
100263398-00	Medicaid	NE
1639426281	Medicaid	ME
34D2044309	Other	NC	CLIA
7001489	Medicaid	NC
MA102377695-003	Medicaid	PA
323804001	Medicaid	TX
3910005749	Medicaid	WV
COS 00800469	Other	CA	STATE OF CALIFORNIA DEPT OF PUBLIC HEALTH, CLINICAL LAB LICENSE
033220	Other	PA	STATE OF PENNSYLVANIA, DOH, CLINICAL LAB PERMIT
853726	Medicaid	AZ
0080201	Medicaid	OH
06785780	Medicaid	MS
1639426281	Medicaid	WA
1639426281	Medicaid	UT
200311320 C	Medicaid	OK
200656570D	Medicaid	KS
200958790C	Medicaid	IN
3089901	Medicaid	NH
38871564	Medicaid	CO
7100257370	Medicaid	KY
9921200	Medicaid	FL
003131635A	Medicaid	GA
085542800	Medicaid	DC
1023532	Medicaid	VT
1639426281	Medicaid	WI
2027	Other	MD	STATE OF MARYLAND CLINICAL LABORATORY PERMIT
770365889-003	Medicaid	IL
800026876	Other	FL	STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, LAB LICENSE
8666040	Other		COLLEGE OF AMERICAN PATHOLOGISTS (CAP) ACCREDITATION
0348244	Medicaid	NJ
1639426281	Medicaid	WY
1639426281	Medicaid	VA
4192451-02	Medicaid	MD
10084550	Medicaid	NM
150243	Medicaid	AL
1639426281	Medicaid	ID
C201222100195-1	Other	NC	NORTH CAROLINA CERTIFICATE OF AUTHORITY (LLC)
LB011NC	Medicaid	AK

Other names 1

Sequenom Laboratories Doing business as

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Laboratory Corporation of America Holdings
- Clinical Medical Laboratory
- Matthews, NC
- NPI 1972946267
Member Of
NPD member

Locations

Dept LA 24114
Pasadena, CA 91185

7010 Kit Creek Rd
#M
Morrisville, NC 27560
Phone (877) 821-7266

NPI Registry JSON

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1639426281",
    "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": "7010 KIT CREEK RD",
            "address_2": "(PHYSICAL ONLY - NO USPS MAIL DELIVERY)",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275609761",
            "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": "2012-08-13",
        "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_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
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            "license": "34D2044309",
            "primary": true
        }
    ],
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            "identifier": "COS 00800469",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
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            "identifier": "033220",
            "state": "PA"
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            "state": "AZ"
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            "identifier": "0080201",
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        {
            "code": "05",
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            "issuer": null,
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        {
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            "state": "UT"
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        {
            "code": "05",
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            "code": "05",
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            "desc": "MEDICAID",
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        },
        {
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        {
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        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
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            "identifier": "C201222100195-1",
            "state": "NC"
        },
        {
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            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LB011NC",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sequenom Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morrisville, NC

Sources for this page

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.