Provider Demographics
NPI:1518184688
Name:YDI CARE DIAGNOSTICS INC
Entity Type:Organization
Organization Name:YDI CARE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GURROLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-852-3543
Mailing Address - Street 1:3610 AVENUE Q
Mailing Address - Street 2:SUITE 216
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-1246
Mailing Address - Country:US
Mailing Address - Phone:918-852-3543
Mailing Address - Fax:
Practice Address - Street 1:7127 RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5053
Practice Address - Country:US
Practice Address - Phone:918-852-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory