Healthcare Provider Details

I. General information

NPI: 1104218775
Provider Name (Legal Business Name): BTDI JV, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 8TH AVE
FORT WORTH TX
76104-4102
US

IV. Provider business mailing address

1431 PERRONE WAY
FRANKLIN TN
37069-4243
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-9729
  • Fax: 888-854-1510
Mailing address:
  • Phone: 615-661-9200
  • Fax: 615-661-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRISTIAN RICE JR.
Title or Position: PRESIDENT
Credential:
Phone: 615-661-9200