Provider Demographics
NPI:1376914218
Name:BLUESCRUBS DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:BLUESCRUBS DIAGNOSTICS, LLC
Other - Org Name:BLUESCRUBS MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-220-8619
Mailing Address - Street 1:4100 SPRING VALLEY RD STE 632
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3629
Mailing Address - Country:US
Mailing Address - Phone:972-220-8619
Mailing Address - Fax:972-421-1674
Practice Address - Street 1:4100 SPRING VALLEY RD STE 632
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:972-220-8619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationGroup - Single Specialty