Provider Demographics
NPI:1215302245
Name:BEECHTREE DIAGNOSTICS LLP
Entity type:Organization
Organization Name:BEECHTREE DIAGNOSTICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-890-7971
Mailing Address - Street 1:PO BOX 35146
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5146
Mailing Address - Country:US
Mailing Address - Phone:801-893-2773
Mailing Address - Fax:801-683-9907
Practice Address - Street 1:12351 S GATEWAY PARK PL STE D-700
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9581
Practice Address - Country:US
Practice Address - Phone:801-893-2773
Practice Address - Fax:801-683-9907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABPARTNER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTMED00041092015291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1215302245Medicaid
UT46D2103212OtherCLIA