Provider Demographics
NPI:1598416190
Name:GOLD TOUCH DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:GOLD TOUCH DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MODIRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-363-9555
Mailing Address - Street 1:1202 MEADOWBANK LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-5671
Mailing Address - Country:US
Mailing Address - Phone:317-363-9555
Mailing Address - Fax:
Practice Address - Street 1:1202 MEADOWBANK LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-5671
Practice Address - Country:US
Practice Address - Phone:317-363-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service