MEDICARE: INFORM DIAGNOSTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1467433292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFORM DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	1111 S FREEPORT PKWY
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4435
Country	:	US
Telephone Number	:	866-588-3280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 S FREEPORT PKWY
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4435
Country	:	US
Telephone Number	:	866-588-3280
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JIAN XIE
Credential	:
Telephone Number	:	626-350-0537

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	12/29/2025

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