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General NPI Number Information
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NPI Number | 1720162514
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Entity Type | Organization
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Legal Business Name | ACTIVE DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 3 MARYLAND FARMS STE 200
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City | BRENTWOOD
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State | TN
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Zip | 37027-5005
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Country | US
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Telephone | 800-348-4565
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Fax | 615-345-5405
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Provider Business Mailing Address
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Address Line | 3 MARYLAND FARMS STE 200
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City | BRENTWOOD
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State | TN
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Zip | 37027-5005
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Country | US
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Telephone | 800-348-4565
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Fax | 615-345-5405
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT, CFO AND C
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Name | MR. JEFFREY GRAY
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Credential |
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Telephone | 800-348-4565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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