Provider Demographics
NPI:1548604051
Name:INFORM DIAGNOSTICS, INC
Entity Type:Organization
Organization Name:INFORM DIAGNOSTICS, INC
Other - Org Name:(F/K/A CARIS DIAGNOSTICS, INC.)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP, COMPLIANCE, ETHICS & QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-8700
Mailing Address - Street 1:6655 NORTH MACARTHUR BOULEVARD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-596-7031
Mailing Address - Fax:
Practice Address - Street 1:9978 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CAMP DENNISON
Practice Address - State:OH
Practice Address - Zip Code:45111-9717
Practice Address - Country:US
Practice Address - Phone:800-979-8292
Practice Address - Fax:972-767-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH209211Medicare PIN