Provider Demographics
NPI:1972520955
Name:ACCESS DIAGNOSTIC INC
Entity type:Organization
Organization Name:ACCESS DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-833-6388
Mailing Address - Street 1:5575 CONNER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-6400
Mailing Address - Country:US
Mailing Address - Phone:313-833-6388
Mailing Address - Fax:
Practice Address - Street 1:5575 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-6400
Practice Address - Country:US
Practice Address - Phone:313-833-6388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJR219490291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherTAX ID
MI0N54600Medicare PIN
MA=========OtherTAX ID