Provider Demographics
NPI:1376299289
Name:GOLDEN HEARTS DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:GOLDEN HEARTS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, CDP
Authorized Official - Phone:575-415-5195
Mailing Address - Street 1:1810 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5051
Mailing Address - Country:US
Mailing Address - Phone:575-440-0044
Mailing Address - Fax:575-551-7500
Practice Address - Street 1:1810 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5051
Practice Address - Country:US
Practice Address - Phone:575-440-0044
Practice Address - Fax:575-551-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory