1548604051 NPI number — INFORM DIAGNOSTICS, INC

Table of content: (NPI 1548604051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548604051 NPI number — INFORM DIAGNOSTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFORM 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:
(F/K/A CARIS DIAGNOSTICS, INC.)
Provider Other Organization Name Type Code:
4
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:
1548604051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6655 NORTH MACARTHUR BOULEVARD
Provider Second Line Business Mailing Address:
ATTN: PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75039-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-596-7031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9978 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP DENNISON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45111-9717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-979-8292
Provider Business Practice Location Address Fax Number:
972-767-0126
Provider Enumeration Date:
04/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SIMONDS
Authorized Official First Name:
DANA
Authorized Official Middle Name:
ARLENE
Authorized Official Title or Position:
SVP, COMPLIANCE, ETHICS & QUALITY
Authorized Official Telephone Number:
214-277-8700

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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