Basic Information
| Provider Information | |||||||||
| NPI: | 1659511822 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIOPSY DIAGNOSTICS, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BXDX CLINICAL LABORATORIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 BROWNS COVE RD | ||||||||
| Address2: | STE. 6 | ||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299368182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 MARSH POINT RD | ||||||||
| Address2: | STE. 303 | ||||||||
| City: | NEPTUNE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2009 | ||||||||
| LastUpdateDate: | 03/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | ZHU | ||||||||
| AuthorizedOfficialFirstName: | WEIJIAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8433792939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.