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General NPI Number Information
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NPI Number | 1518184688
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Entity Type | Organization
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Legal Business Name | YDI CARE DIAGNOSTICS INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 7127 RIVERSIDE DR SUITE 100
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City | TULSA
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State | OK
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Zip | 74136-5053
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Country | US
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Telephone | 918-852-3543
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 AVENUE Q SUITE 216
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City | LUBBOCK
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State | TX
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Zip | 79412-1246
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Country | US
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Telephone | 918-852-3543
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN R GURROLA
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Credential |
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Telephone | 918-852-3543
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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 |
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License Number State |
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