Provider Demographics
NPI:1962724880
Name:AMERICAN INTERNATIONAL BIOTECHNOLOGY AIBIOTECH
Entity type:Organization
Organization Name:AMERICAN INTERNATIONAL BIOTECHNOLOGY AIBIOTECH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOSTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-648-3820
Mailing Address - Street 1:601 BIOTECH DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5167
Mailing Address - Country:US
Mailing Address - Phone:804-648-3820
Mailing Address - Fax:804-648-2641
Practice Address - Street 1:601 BIOTECH DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5167
Practice Address - Country:US
Practice Address - Phone:804-648-3820
Practice Address - Fax:804-648-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100012573Medicaid