Immucor Gti Diagnostics, Inc.
Organization Active NPI Clinical Medical Laboratory · Grand Rapids, MI
NPI 1669840674 · NPPES record last updated Apr 15, 2021
Key facts
- NPI
- 1669840674
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 23D1054909 (MI)
- Legal business name
- IMMUCOR GTI DIAGNOSTICS, INC.
- Practice address
- 301 Michigan St NE
Suite 580
Grand Rapids, MI 49503-3314 - Phone
- (616) 284-3818
- Fax
- (616) 284-3838
- NPI assigned
- Sep 8, 2015
- Organization subpart
- No
Authorized official
- Name
- Ms. Margaret Taylor
- Title
- Vice President, Chief Administrativ
- Phone
- (770) 225-8501
National Provider Directory
Locations
301 Michigan St NE
Ste 574
Grand Rapids, MI 49503
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 23D1054909 | MI | Yes |
Addresses
Primary practice location
301 Michigan St NE
Suite 580
Grand Rapids, MI 49503-3314
Mailing address
301 Michigan St NE Ste 574
Grand Rapids, MI 49503-3314
Phone (616) 284-3818
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 031049 | Other | PA | STATE LICENSURE |
| 156426 | Medicaid | AZ | |
| 7100431260 | Medicaid | KY | |
| COS00800270 | Other | CA | STATE LICENSE |
| 1571 | Other | MD | STATE LICENSE |
| 23D1054909 | Other | MI | CLIA CERTIFICATION |
| 201131960A | Medicaid | KS | |
| 800028023 | Other | FL | STATE LICENSE |
| L00526 | Medicaid | SC | |
| LCO00995 | Other | RI | STATE LICENSE |
| 1669840674 | Medicaid | MI |
Other names
- Immucor DX
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.