Provider Demographics
NPI:1376910018
Name:INTEGRON LLC
Entity Type:Organization
Organization Name:INTEGRON LLC
Other - Org Name:ADVANCED DIAGNOSTICS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOEPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-217-3519
Mailing Address - Street 1:5139 SHARP STREET
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247
Mailing Address - Country:US
Mailing Address - Phone:214-225-1230
Mailing Address - Fax:
Practice Address - Street 1:5139 SHARP STREET
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-225-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory