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General NPI Number Information
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NPI Number | 1689284986
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Entity Type | Organization
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Legal Business Name | ON DEMAND DIAGNOSTICS LLC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 297 HIGHWAY 51 STE C
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City | RIDGELAND
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State | MS
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Zip | 39157-3423
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Country | US
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Telephone | 601-966-5601
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Fax |
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Provider Business Mailing Address
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Address Line | 6088 HUNTVIEW DR
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City | JACKSON
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State | MS
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Zip | 39206-2130
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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 | OWNER
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Name | RONALD HEWITT
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Credential |
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Telephone | 601-966-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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