Provider Demographics
NPI:1083134209
Name:WISE DIAGNOSTIC SYSTEMS, LLC
Entity Type:Organization
Organization Name:WISE DIAGNOSTIC SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-351-4756
Mailing Address - Street 1:1776 WOODSTEAD CT STE 107
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1450
Mailing Address - Country:US
Mailing Address - Phone:855-947-3391
Mailing Address - Fax:855-947-3391
Practice Address - Street 1:1776 WOODSTEAD CT STE 107
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1450
Practice Address - Country:US
Practice Address - Phone:281-292-7411
Practice Address - Fax:281-292-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory