Organization
IMMUCOR GTI DIAGNOSTICS, INC.
Active
Other names
Immucor DX
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARGARET TAYLOR (VICE PRESIDENT, CHIEF ADMINISTRATIV)
(770) 225-8501
Entity
Organization
Contact information
Practice address
301 MICHIGAN ST NE, SUITE 580, GRAND RAPIDS, MI 49503-3314
(616) 284-3818
(616) 284-3838
Mailing address
301 MICHIGAN ST NE STE 574, GRAND RAPIDS, MI 49503-3314
(616) 284-3818
(616) 284-3738
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
23D1054909
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031049
STATE LICENSURE
PA
05
—
156426
—
AZ
01
—
1571
STATE LICENSE
MD
05
—
1669840674
—
MI
05
—
201131960A
—
KS
01
—
23D1054909
CLIA CERTIFICATION
MI
05
—
7100431260
—
KY
01
—
800028023
STATE LICENSE
FL
01
—
COS00800270
STATE LICENSE
CA
05
—
L00526
—
SC
01
—
LCO00995
STATE LICENSE
RI
Enumeration date
09/08/2015
Last updated
04/15/2021
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