1215204359 NPI number — VIVERE-DALLAS FERTILITY LABORATORY LLC

Table of content: (NPI 1215204359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215204359 NPI number — VIVERE-DALLAS FERTILITY LABORATORY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIVERE-DALLAS FERTILITY LABORATORY LLC
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:
1215204359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 COOL SPRINGS BLVD
Provider Second Line Business Mailing Address:
SUITE 520
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-2626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-550-4900
Provider Business Mailing Address Fax Number:
615-550-4901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12606 GREENVILLE AVE
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-475-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEPLEY
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
615-550-4913

Provider Taxonomy Codes

  • 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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