Provider Demographics
NPI:1417677055
Name:PRADUS DIAGNOSTIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:PRADUS DIAGNOSTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:832-562-9692
Mailing Address - Street 1:2840 BILL OWENS PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2150
Mailing Address - Country:US
Mailing Address - Phone:855-977-2387
Mailing Address - Fax:
Practice Address - Street 1:2480D BILL OWENS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2150
Practice Address - Country:US
Practice Address - Phone:832-562-9692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory