Provider Demographics
NPI:1639727662
Name:DIGITAL DIAGNOSTICS INC.
Entity Type:Organization
Organization Name:DIGITAL DIAGNOSTICS INC.
Other - Org Name:IDX LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-248-5620
Mailing Address - Street 1:2300 OAKDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9702
Mailing Address - Country:US
Mailing Address - Phone:319-248-5620
Mailing Address - Fax:319-343-1052
Practice Address - Street 1:3700 N CAPITAL OF TEXAS HWY STE 450
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-0034
Practice Address - Country:US
Practice Address - Phone:512-231-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory