Provider Demographics
NPI:1235450743
Name:USMD DIAGNOSTIC SERVICES, LLC
Entity Type:Organization
Organization Name:USMD DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-493-4000
Mailing Address - Street 1:6333 N. STATE HIGHWAY 161, STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2216
Mailing Address - Country:US
Mailing Address - Phone:214-493-4000
Mailing Address - Fax:
Practice Address - Street 1:1300 W TERRELL AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2820
Practice Address - Country:US
Practice Address - Phone:214-493-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2016-11-17
Deactivation Date:2015-09-15
Deactivation Code:
Reactivation Date:2016-11-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory