Organization
IVERSON GENETIC DIAGNOSTICS, INC.
Active
Other names
Iverson Genetic Diagnostics Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH CLOUSE (CEO)
(720) 284-7526
Entity
Organization
Contact information
Practice address
645 MEETING STREET, CHARLESTON, SC 29403
(843) 789-5912
(888) 909-9784
Mailing address
645 MEETING STREET, CHARLESTON, SC 29403
(843) 789-5912
(888) 909-9784
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
MTS-5156
WA
291U00000X
Clinical Medical Laboratory
Primary
MTSC.FS.600017885
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50D1072592
CLIA #
WA
01
—
50D1083740
CLIA
WA
05
—
7141252
—
WA
Enumeration date
08/21/2007
Last updated
11/02/2016
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