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General NPI Number Information
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NPI Number | 1932058195
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Entity Type | Organization
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Legal Business Name | INTERVENTION ONE DIAGNOSTIC LLC
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 4510 OFFICE PARK DR
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City | JACKSON
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State | MS
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Zip | 39206-6016
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Country | US
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Telephone | 662-834-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 8586 CRAVEN RD
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City | BARTLETT
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State | TN
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Zip | 38002-9358
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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 | AUTHORIZED OFFICIAL/ OWNER
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Name | MAURICE HAMPTON
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Credential |
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Telephone | 901-230-7646
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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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