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General NPI Number Information
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NPI Number | 1487325981
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Entity Type | Organization
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Legal Business Name | INFORM DIAGNOSTICS, INC
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 5 BRIDLE PATH
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City | LONGVIEW
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State | TX
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Zip | 75605-7266
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Country | US
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Telephone | 214-277-8700
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Fax | 214-596-2280
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Provider Business Mailing Address
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Address Line | 6655 N MACARTHUR BLVD ATTN: PROVIDER ENROLLMENT
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City | IRVING
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State | TX
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Zip | 75039-2443
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Country | US
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Telephone | 214-277-8700
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Fax | 214-596-2280
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Authorized Official
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Title or Position | SVP - CHIEF COMPLIANCE & ETHICS OFF
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Name | BARBARA WOLF
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Credential |
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Telephone | 214-596-2235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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