Provider Demographics
NPI:1164166567
Name:FREEDOM DIAGNOSTIC TESTING, PLLC
Entity Type:Organization
Organization Name:FREEDOM DIAGNOSTIC TESTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:217-675-7072
Mailing Address - Street 1:715 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1733
Mailing Address - Country:US
Mailing Address - Phone:217-675-7072
Mailing Address - Fax:217-334-1313
Practice Address - Street 1:715 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1733
Practice Address - Country:US
Practice Address - Phone:217-675-7072
Practice Address - Fax:217-334-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty