Provider Demographics
NPI:1902474653
Name:SEMA4 OPCO, INC
Entity Type:Organization
Organization Name:SEMA4 OPCO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATIMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-429-3142
Mailing Address - Street 1:333 LUDLOW ST FL TOWER8
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-6987
Mailing Address - Country:US
Mailing Address - Phone:475-333-3621
Mailing Address - Fax:475-333-3810
Practice Address - Street 1:62 SOUTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7229
Practice Address - Country:US
Practice Address - Phone:800-298-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
07D2180805OtherCLIA