Provider Demographics
NPI:1295008860
Name:DIAGNOSTIC & INTERVENTION SERVICES PC
Entity Type:Organization
Organization Name:DIAGNOSTIC & INTERVENTION SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-576-5000
Mailing Address - Street 1:PO BOX 23869
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-3869
Mailing Address - Country:US
Mailing Address - Phone:602-576-5000
Mailing Address - Fax:602-707-7571
Practice Address - Street 1:2120 S RURAL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1400
Practice Address - Country:US
Practice Address - Phone:602-576-5000
Practice Address - Fax:602-707-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty