1548604051 NPI number — INFORM DIAGNOSTICS, INC

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 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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