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General NPI Number Information
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NPI Number | 1477910404
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Entity Type | Organization
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Legal Business Name | INTUIT DIAGNOSTIC LABORATORY MANAGEMENT LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 4225 OFFICE PKWY
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City | DALLAS
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State | TX
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Zip | 75204-3628
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Country | US
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Telephone | 817-454-3043
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Fax |
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Provider Business Mailing Address
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Address Line | 4225 OFFICE PKWY
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City | DALLAS
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State | TX
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Zip | 75204-3628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, FINANCE
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Name | RYAN KING
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Credential |
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Telephone | 817-454-3043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D2086654
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License Number State | TX
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