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Contact Information

IVERSON GENETIC DIAGNOSTICS, INC.
645 MEETING STREET
CHARLESTON, SC29403
 Phone: 843-789-5912
 Fax: 888-909-9784
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
Indicates primary specialty

NPI Profile & details for IVERSON GENETIC DIAGNOSTICS, INC.

NPI Number 1992998157
LBN Legal business name IVERSON GENETIC DIAGNOSTICS, INC.
Authorized official JOSEPH CLOUSE - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 08/21/2007
Last updated 11/02/2016 - About 10 years ago
Identifiers
WA License # MTS-5156
WA License # MTSC.FS.600017885
WA Medicaid 7141252
WA Other 50D1083740 CLIA
WA Other 50D1072592 CLIA #
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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