Basic Information
| Provider Information | |||||||||
| NPI: | 1235768334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR DIAGNOSTICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 658 GRASSMERE PARK STE 104 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372113683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159163200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27B TALISMAN DR UNIT 3 | ||||||||
| Address2: | |||||||||
| City: | PAGOSA SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811477914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703720456 | ||||||||
| FaxNumber: | 9705073010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2020 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | PAPAIOANU | ||||||||
| AuthorizedOfficialFirstName: | ATHANASSIOS | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 6159163200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 06D2176866 | 01 | CO | CLIA | OTHER |