Provider Demographics
NPI:1497054282
Name:URBAN DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:URBAN DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, LPT
Authorized Official - Phone:817-800-5630
Mailing Address - Street 1:2716 COUNTY ROAD 804A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1950
Mailing Address - Country:US
Mailing Address - Phone:817-800-5630
Mailing Address - Fax:817-447-9958
Practice Address - Street 1:614 MATLOCK CENTRE CIR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2536
Practice Address - Country:US
Practice Address - Phone:817-800-5630
Practice Address - Fax:817-447-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory