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General NPI Number Information
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NPI Number | 1386166049
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC VASCULAR TESTING, INC.
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 94 SAPPHIRE PT
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City | MORTON
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State | IL
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Zip | 61550-3608
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Country | US
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Telephone | 309-641-0335
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Fax | 309-641-0331
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Provider Business Mailing Address
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Address Line | 94 SAPPHIRE PT
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City | MORTON
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State | IL
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Zip | 61550-3608
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Country | US
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Telephone | 309-641-0335
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Fax | 309-641-0331
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Authorized Official
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Title or Position | PRESIDENT, EXECUTIVE PARTNER
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Name | MRS. JODIE LYNNE STENDEBACK
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Credential | RVT, RDMS
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Telephone | 779-456-5591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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