Provider Demographics
NPI:1285153593
Name:SYNERGIST LABORATORIES, LLC
Entity type:Organization
Organization Name:SYNERGIST LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WAVRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-201-2610
Mailing Address - Street 1:4580 KLAHANIE DR SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5812
Mailing Address - Country:US
Mailing Address - Phone:425-890-6239
Mailing Address - Fax:
Practice Address - Street 1:1910 THOMES AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3527
Practice Address - Country:US
Practice Address - Phone:307-201-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty