Healthcare Provider Details

I. General information

NPI: 1386105914
Provider Name (Legal Business Name): IDL ACQUISITION CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 RIVERSIDE DR STE 1001
FRANKLIN TN
37064-8996
US

IV. Provider business mailing address

357 RIVERSIDE DR STE 1001
FRANKLIN TN
37064-8996
US

V. Phone/Fax

Practice location:
  • Phone: 615-465-6529
  • Fax: 615-465-6531
Mailing address:
  • Phone: 615-465-6529
  • Fax: 615-465-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DAVID MCCREA
Title or Position: CEO
Credential:
Phone: 615-465-6529