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General NPI Number Information
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NPI Number | 1760655294
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Entity Type | Organization
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Legal Business Name | MAXUM HEALTH SERVICES CORP
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 11617 N CENTRAL EXPY MOBILE UNIT
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City | DALLAS
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State | TX
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Zip | 75243-3800
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Country | US
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Telephone | 214-369-3795
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 848074
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City | DALLAS
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State | TX
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Zip | 75284-8074
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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 | SENIOR VP & CHIEF ACCOUNTING OFCR
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Name | BRIAN G DRAZBA
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Credential |
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Telephone | 949-282-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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