NPIViewer - Provider NPI 1124051644

NPI:	1124051644
Name:	BOSTWICK LABORATORIES, INC.
Entity type:	Organization
Organization Name:	BOSTWICK LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	CEO
Authorized Official - Prefix:	MR
Authorized Official - First Name:	MARTIN
Authorized Official - Middle Name:	J
Authorized Official - Last Name:	STEFANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	516-512-5200
Mailing Address - Street 1:	PO BOX 403751
Mailing Address - Street 2:
Mailing Address - City:	ATLANTA
Mailing Address - State:	GA
Mailing Address - Zip Code:	30384-3751
Mailing Address - Country:	US
Mailing Address - Phone:	804-967-9225
Mailing Address - Fax:	804-239-1954
Practice Address - Street 1:	4355 INNSLAKE DR
Practice Address - Street 2:
Practice Address - City:	GLEN ALLEN
Practice Address - State:	VA
Practice Address - Zip Code:	23060-6742
Practice Address - Country:	US
Practice Address - Phone:	804-967-9225
Practice Address - Fax:	804-239-1954
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-07-08
Last Update Date:	2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	291U00000X	Laboratories	Clinical Medical Laboratory

State	Identifier ID	ID Type	Issuer
OH	000000265139	Other	UNISON HEALTH (OH MEDICAID HMO)
DC	036874800	Other	MEDICAID (ACS)
DC	036874800	Medicaid
MT	0421311	Medicaid
PA	1009021320002	Medicaid
WY	120124700	Medicaid
VA	138056	Other	ANTHEM BCBS OF VIRGINIA
TX	164040101	Medicaid
OK	200024720A	Medicaid
CO	32287232	Medicaid
AZ	440615	Medicaid
NM	82083339	Medicaid
MS	01837399	Medicaid
NV	100503849	Medicaid
LA	1198722	Medicaid
WI	32940800	Medicaid
ID	8069026	Medicaid
VA	010062811	Medicaid
IA	0578229	Medicaid
AR	152979709	Medicaid
IN	200375010A	Medicaid
OR	275326 MCD	Medicaid
AL	690000006	Medicaid
MI	164650710	Medicaid
RI	1900009	Medicaid
KS	200262210A	Medicaid
SC	20073351	Other	SC SELECT HEALTH/MEDICAID HMO
OH	2420571	Medicaid
KY	37000718	Medicaid
TN	4582490	Medicaid
GA	568644630A	Medicaid
AZ	533631	Other	MERCY CARE PLAN
NC	7001242	Medicaid
FL	911980900	Medicaid
SC	L00184	Medicaid
MD	409261900	Medicaid
WV	6701112000	Medicaid
ME	419300000	Medicaid
WA	7123995	Medicaid
MN	1124051644	Medicaid
MO	706132305	Medicaid
CO	32287232	Medicaid
TN	4582490	Medicaid
WV	6701112000	Medicaid
IA	0578229	Medicaid
MS	01837399	Medicaid