Basic Information
| Provider Information | |||||||||
| NPI: | 1770738650 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASL-DEN 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: | 6116 E WARREN AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802225703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035122216 | ||||||||
| FaxNumber: | 3036926061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PAPAIOANU | ||||||||
| AuthorizedOfficialFirstName: | ATHANASSIOS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 6159163200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 800026147 | FL | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 2125 | MD | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 06D0512826 | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 445399 | 05 | AZ | MEDICAID | 7100300880 | 05 | KY | MEDICAID | 0145662-00 | 05 | FL | MEDICAID | 1770738650 | 05 | MT | MEDICAID | 1770738650 | 05 | NC | MEDICAID | 2040427 | 05 | WA | MEDICAID | 200239440A | 05 | OK | MEDICAID | 1770738650 | 05 | NV | MEDICAID | 58200878 | 05 | NM | MEDICAID | 10025736500 | 05 | NE | MEDICAID | 1770738650 | 05 | ID | MEDICAID | 1770738650 | 05 | VA | MEDICAID | 1770738650 | 05 | MO | MEDICAID | 1770738650 | 05 | UT | MEDICAID | 200601720A | 05 | KS | MEDICAID | 210087709 | 05 | AR | MEDICAID | 88509761 | 05 | CO | MEDICAID | 127960200 | 05 | WY | MEDICAID | 1770738650 | 05 | SD | MEDICAID |