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NPI Code Detail

MEDICARE: INTERVENE ONE DIAGNOSTIC LLC

MEDICARE: INTERVENE ONE DIAGNOSTIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1932058195
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERVENE ONE DIAGNOSTIC LLC
Provider Business Mailing Address
First Line : 8586 CRAVEN RD
Second Line :
City : BARTLETT
State : TN
Zip : 38002-9358
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 662-834-3432
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL/ OWNER
Name : MAURICE HAMPTON
Credential :
Telephone Number : 901-230-7646
Provider Enumeration Date : 01/22/2026
Last Update Date : 04/09/2026

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Directions to “INTERVENE ONE DIAGNOSTIC LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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