PEACHSTATE HEALTH MANAGEMENT LLC (AEON CLINICAL LABORATORIES) - NPI NUMBER 1972888139

Summary

Provider Name: PEACHSTATE HEALTH MANAGEMENT LLC (AEON CLINICAL LABORATORIES)

NPI Number: 1972888139

Clasification: Clinical Medical Laboratory (291U00000X)

Address:
2225 CENTENNIAL DR
GAINESVILLE, GA
ZIP 30504

Phone Number: (678) 276-8411



Detailed Information

PEACHSTATE HEALTH MANAGEMENT LLC is a clinical medical laboratory in Gainesville, GA. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. The assigned NPI number for this provider is 1972888139 and is registered as an organization entity type.
The provider Is Doing Business As Aeon Clinical Laboratories.

The provider's business address is:

2225 CENTENNIAL DR
GAINESVILLE, GA
ZIP 30504-760
Phone: (678) 276-8411
Fax: (678) 971-4830

The provider's authorized official is Shawn Desai .
The authorized official title is Lab Operations Manager and has the following contact phone number (678) 276-8411.

The enumeration date for this NPI number is 10/19/2011 and was last updated on 11/14/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 291U00000X Clinical Medical Laboratory Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1972888139 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name PEACHSTATE HEALTH MANAGEMENT LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name AEON CLINICAL LABORATORIES Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 2225 CENTENNIAL DR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name GAINESVILLE The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name GA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 305045760 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 6782768411 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 6789714830 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 10/19/2011 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 11/14/2013 The date that a record was last updated or changed.
16 Authorized Official Last Name DESAI The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name SHAWN The first name of the authorized official.
18 Authorized Official Title or Position LAB OPERATIONS MANAGER The title or position of the authorized official.
19 Authorized Official Telephone Number 6782768411 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 291U00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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