1033362876 NPI number — HEALTHLINE DIAGNOSTICS, INC

Table of content: (NPI 1033362876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033362876 NPI number — HEALTHLINE DIAGNOSTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHLINE 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:
1033362876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2142
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75091-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-813-0300
Provider Business Mailing Address Fax Number:
903-891-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4833 SPICEWOOD SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759-7253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-477-0500
Provider Business Practice Location Address Fax Number:
512-477-9232
Provider Enumeration Date:
10/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
903-813-0300

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PL7260 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com