1386166049 NPI number — DIAGNOSTIC VASCULAR TESTING, INC.

Table of content: (NPI 1386166049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386166049 NPI number — DIAGNOSTIC VASCULAR TESTING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC VASCULAR TESTING, 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:
1386166049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 SAPPHIRE PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61550-3608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-641-0335
Provider Business Mailing Address Fax Number:
309-641-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 SAPPHIRE PT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61550-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-641-0335
Provider Business Practice Location Address Fax Number:
309-641-0331
Provider Enumeration Date:
07/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
STENDEBACK
Authorized Official First Name:
JODIE
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
PRESIDENT, EXECUTIVE PARTNER
Authorized Official Telephone Number:
779-456-5591

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com