1992043640 NPI number — DISTINCTIVE DIAGNOSTICS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992043640 NPI number — DISTINCTIVE DIAGNOSTICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISTINCTIVE DIAGNOSTICS, PLLC
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:
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:
1992043640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 108810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73101-8810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-675-0905
Provider Business Mailing Address Fax Number:
214-317-4888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4516 LOVERS LN
Provider Second Line Business Practice Location Address:
#331
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225-6925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-675-0905
Provider Business Practice Location Address Fax Number:
214-317-4888
Provider Enumeration Date:
01/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PARCHURI
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-675-0905

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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