Provider Demographics
NPI:1598210353
Name:INHEALTH DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:INHEALTH DIAGNOSTIC, LLC
Other - Org Name:REAL LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-674-1913
Mailing Address - Street 1:17742 PRESTON RD SUITE #210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6199
Mailing Address - Country:US
Mailing Address - Phone:972-674-1913
Mailing Address - Fax:903-224-8322
Practice Address - Street 1:17742 PRESTON RD SUITE #210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6199
Practice Address - Country:US
Practice Address - Phone:972-674-1913
Practice Address - Fax:903-224-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2117218291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364590501Medicaid
TX539999Medicare PIN