Healthcare Provider Details

I. General information

NPI: 1972748424
Provider Name (Legal Business Name): INFORM DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 44TH ST STE 200
PHOENIX AZ
85008-6535
US

IV. Provider business mailing address

1111 S FREEPORT PKWY ATTN: PROVIDER ENROLLMENT/CREDENTIALING
COPPELL TX
75019-4435
US

V. Phone/Fax

Practice location:
  • Phone: 866-588-3280
  • Fax: 972-767-0225
Mailing address:
  • Phone: 866-588-3280
  • Fax: 972-767-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JIAN XIE
Title or Position: COO
Credential:
Phone: 626-350-0537