Healthcare Provider Details

I. General information

NPI: 1447039565
Provider Name (Legal Business Name): BTDI JV, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W EXCHANGE PKWY STE 2100
ALLEN TX
75013-1202
US

IV. Provider business mailing address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2742
US

V. Phone/Fax

Practice location:
  • Phone: 469-656-7723
  • Fax: 469-795-0289
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KATE ROELLE
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 614-689-1691