Provider Demographics
NPI:1275301517
Name:ROCKY RIDGE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:ROCKY RIDGE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-999-0800
Mailing Address - Street 1:8131 LYNDON B JOHNSON FWY # 260
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1311
Mailing Address - Country:US
Mailing Address - Phone:214-999-0800
Mailing Address - Fax:469-270-0778
Practice Address - Street 1:8131 LYNDON B JOHNSON FWY # 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1311
Practice Address - Country:US
Practice Address - Phone:214-999-0800
Practice Address - Fax:469-270-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory