Healthcare Provider Details

I. General information

NPI: 1730543570
Provider Name (Legal Business Name): BTDI JV LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 RICHLAND WEST CIR
WACO TX
76712-7919
US

IV. Provider business mailing address

PO BOX 746003
ATLANTA GA
30374-6003
US

V. Phone/Fax

Practice location:
  • Phone: 214-647-6161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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