Provider Demographics
NPI:1326743535
Name:HEALTHTRACKRX INDIANA, INC
Entity Type:Organization
Organization Name:HEALTHTRACKRX INDIANA, INC
Other - Org Name:HEALTHTRACKRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:BISOGNO
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-444-7701
Mailing Address - Street 1:1500 INTERSTATE 35 W
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-2402
Mailing Address - Country:US
Mailing Address - Phone:866-287-3218
Mailing Address - Fax:214-975-2717
Practice Address - Street 1:706 E LEWIS AND CLARK PKWY UNIT 11
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2245
Practice Address - Country:US
Practice Address - Phone:972-833-4687
Practice Address - Fax:214-975-2717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHTRACKRX INDIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
15D2267792OtherCLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA)