Organization
IMMUCOR GTI DIAGNOSTICS, INC.
Active
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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