Healthcare Provider Details

I. General information

NPI: 1821480583
Provider Name (Legal Business Name): BTDI JV, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11575 JOLLYVILLE RD
AUSTIN TX
78759-4028
US

IV. Provider business mailing address

PO BOX 746003
ATLANTA GA
30374-6003
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-9597
  • Fax:
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