Basic Information
Provider Information | |||||||||
NPI: | 1386895969 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CEDAR DIAGNOSTICS, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 658 GRASSMERE PARK STE 104 | ||||||||
Address2: |   | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372113683 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6159163200 | ||||||||
FaxNumber: | 6159163218 | ||||||||
Practice Location | |||||||||
Address1: | 1011 N MILDRED RD | ||||||||
Address2: |   | ||||||||
City: | CORTEZ | ||||||||
State: | CO | ||||||||
PostalCode: | 813212435 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9705658482 | ||||||||
FaxNumber: | 9705658478 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/01/2008 | ||||||||
LastUpdateDate: | 12/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PAPAIOANU | ||||||||
AuthorizedOfficialFirstName: | ATHANASSIOS | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
AuthorizedOfficialTelephone: | 6159163200 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 06D1089490 | CO | Y |   | Laboratories | Clinical Medical Laboratory |   |
ID Information
ID | Type | State | Issuer | Description | 06D2154705 | 01 | CO | CLIA | OTHER | 06D1065912 | 01 | CO | CLIA | OTHER | 06D1089490 | 01 | CO | CLIA | OTHER |