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General NPI Number Information
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NPI Number | 1164166567
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Entity Type | Organization
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Legal Business Name | FREEDOM DIAGNOSTIC TESTING, PLLC
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 715 S MAIN ST
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City | HILLSBORO
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State | IL
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Zip | 62049-1733
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Country | US
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Telephone | 217-675-7072
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Fax | 217-334-1313
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Provider Business Mailing Address
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Address Line | 715 S MAIN ST
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City | HILLSBORO
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State | IL
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Zip | 62049-1733
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Country | US
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Telephone | 217-675-7072
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Fax | 217-334-1313
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Authorized Official
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Title or Position | CO-OWNER
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Name | SARA BETH DUFF
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Credential | CPT
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Telephone | 217-675-7072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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