Provider Demographics
NPI:1033203393
Name:CENTER FOR DISEASE DETECTION LLC
Entity Type:Organization
Organization Name:CENTER FOR DISEASE DETECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-7566
Mailing Address - Street 1:PO BOX 659509
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9509
Mailing Address - Country:US
Mailing Address - Phone:210-590-3033
Mailing Address - Fax:210-590-3121
Practice Address - Street 1:11603 CROSSWINDS WAY STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6005
Practice Address - Country:US
Practice Address - Phone:210-590-3033
Practice Address - Fax:210-590-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0793742OtherCOLORADO MEDICAID
CAXLAB60475OtherCALIFORNIA MEDI-CAL
033332OtherFAMILY HEALTH PARTNERS
TX095210302Medicaid
095210302OtherAMERIGROUP TEXAS INC
003126019OtherCONNECTICUT
7106123OtherADAPTIS
565848OtherCCN
730813OtherBUCKEYE COMMUNITY PLAN
976813OtherARIZONA MEDICAID
TXCL5132OtherBLUECROSS BLUESHIELD
LB142TXOtherALASKA MEDICAID
20039659OtherAMERIHEALTH MERCY
AL690000009OtherALABAMA MEDICAID
AR156260709OtherARKANSAS MEDICAID
232921142000OtherCARESOURCE
095210302OtherAMERIGROUP TEXAS INC
TXCL5132OtherBLUECROSS BLUESHIELD
033332OtherFAMILY HEALTH PARTNERS
TXCL5132OtherBLUECROSS BLUESHIELD