=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619643632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TECHNICAL RESOURCE MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2021
-----------------------------------------------------
Last Update Date | 04/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5604 FORTUNE CIR S STE N
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46241-5529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-895-8090
-----------------------------------------------------
Fax | 303-371-0345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 172775
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80217-2775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-895-8090
-----------------------------------------------------
Fax | 303-371-0345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF CREDENTIALING AND ENROLL
-----------------------------------------------------
Name | SYLVIA L FREEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-304-7602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------