Provider Demographics
NPI:1275876591
Name:DAVINCI INNOVATIONS, LLC
Entity Type:Organization
Organization Name:DAVINCI INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-598-7272
Mailing Address - Street 1:PO BOX 847090
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7090
Mailing Address - Country:US
Mailing Address - Phone:844-384-5887
Mailing Address - Fax:807-270-7384
Practice Address - Street 1:9150 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3843
Practice Address - Country:US
Practice Address - Phone:844-384-5887
Practice Address - Fax:807-270-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL13000030595291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2069185OtherCLIA#
MI23D2071783OtherCLIA#
VA49D2069987OtherCLIA#
VA49D2069987OtherCLIA#