Provider Demographics
NPI:1477558179
Name:IMMUNO D, INC.
Entity Type:Organization
Organization Name:IMMUNO D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-5809
Mailing Address - Street 1:8122 DATAPOINT DR
Mailing Address - Street 2:STE 910
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3273
Mailing Address - Country:US
Mailing Address - Phone:210-614-5809
Mailing Address - Fax:210-615-8186
Practice Address - Street 1:8122 DATAPOINT DR
Practice Address - Street 2:STE 910
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3273
Practice Address - Country:US
Practice Address - Phone:210-614-5809
Practice Address - Fax:210-615-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL0577Medicare ID - Type Unspecified