Iverson Genetic Diagnostics, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

MTSC.FS.600017885 Issued in WA

Legal business name

IVERSON GENETIC DIAGNOSTICS, INC.

Practice address

645 Meeting Street
Charleston, SC 29403

Phone

(843) 789-5912

Fax

(888) 909-9784

NPI assigned

Aug 21, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Joseph Clouse

Title

Ceo

Phone

(720) 284-7526

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Iverson Genetic Diagnostics Inc Doing business as

Locations

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1992998157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 MEETING STREET",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-789-5912",
            "fax_number": "888-909-9784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 MEETING STREET",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-789-5912",
            "fax_number": "888-909-9784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVERSON GENETIC DIAGNOSTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "CLOUSE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "720-284-7526",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WA",
            "license": "MTS-5156",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WA",
            "license": "MTSC.FS.600017885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "50D1072592",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "50D1083740",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7141252",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iverson Genetic Diagnostics Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Saima Ismaili, DPM
• Alexis Isom
• Hannah Michelle Istre-Wilz, MD
• Rachel Friend Iulo, DNP, MSN, FNP-BC
• Robert Edward Iulo, DMD
• Julius R Ivester Jr., MD
• James Davis Ivey, PA-C
• Kwame N Iwegbue, MD
• J. T. Richards, M.D., P.a.
• Chadi M Jaafar, PHARMD

• Clinical Medical Laboratory in Charleston, SC
• Providers in Charleston, SC by specialty
• Clinical Medical Laboratory in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.