Organization
DOMINION DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDY ELLIS (PAYER RELATIONS REP)
(802) 734-6392
Entity
Organization
Contact information
Practice address
211 CIRCUIT DRIVE, NORTH KINGSTOWN, RI 02852-7440
(877) 734-9600
(401) 667-0330
Mailing address
211 CIRCUIT DRIVE, NORTH KINGSTOWN, RI 02852-7440
(877) 734-9600
(401) 667-0330
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
00343
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1334975
CAP AU-ID
—
01
—
49D0926092
CLIA
—
01
—
7029901
CAP LAP NUMBER
—
Enumeration date
06/27/2005
Last updated
12/14/2022
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