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General NPI Number Information
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NPI Number | 1356809578
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Entity Type | Organization
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Legal Business Name | PREVENTRIC DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 2120 16TH AVE S STE 300
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City | BIRMINGHAM
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State | AL
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Zip | 35205-5046
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Country | US
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Telephone | 205-208-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 16TH AVE S STE 300
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City | BIRMINGHAM
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State | AL
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Zip | 35205-5046
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Country | US
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Telephone | 205-208-1400
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | PHILIP ANDREW WHITE
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Credential | ETC
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Telephone | 205-478-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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