Healthcare Provider Details

I. General information

NPI: 1841542800
Provider Name (Legal Business Name): APSP-ADDISON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 ADDISON RD SUITE 278
ADDISON TX
75001-3297
US

IV. Provider business mailing address

2410 W MEMORIAL RD STE. C432
OKLAHOMA CITY OK
73134-8047
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-2732
  • Fax:
Mailing address:
  • Phone: 405-285-2732
  • Fax:

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: ERNEST DIAZ
Title or Position: CEO
Credential:
Phone: 405-285-2732