1508828773 NPI number — IN-VITRO DIAGNOSTICS INC

Table of content: (NPI 1508828773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508828773 NPI number — IN-VITRO DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN-VITRO DIAGNOSTICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508828773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78680-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-246-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 OLD MCGREGOR RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712-6120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-246-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-246-9000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  45D0659993 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002165800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 025301501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200507540A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100758840A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000458394 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37902731 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CLO394 . This is a "BCBS OF TX PPO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0924639 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00112935 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0898613 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1066360 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100245010A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115149709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5581210 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000461689A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105647600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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