Provider Demographics
NPI:1366678682
Name:ENDEAVOUR DIAGNOSTICS INC
Entity Type:Organization
Organization Name:ENDEAVOUR DIAGNOSTICS INC
Other - Org Name:ADVANCED MEDICAL ANALYSIS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-448-8057
Mailing Address - Street 1:15904 STRATHERN ST
Mailing Address - Street 2:STE 19
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1314
Mailing Address - Country:US
Mailing Address - Phone:818-448-8057
Mailing Address - Fax:
Practice Address - Street 1:1941 WALKER AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4846
Practice Address - Country:US
Practice Address - Phone:818-448-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF10748291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory