Provider Demographics
NPI:1649758038
Name:PRUVEN HEALTH
Entity Type:Organization
Organization Name:PRUVEN HEALTH
Other - Org Name:BIOSTAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-310-9888
Mailing Address - Street 1:4841 KELLER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5912
Mailing Address - Country:US
Mailing Address - Phone:605-484-8803
Mailing Address - Fax:214-261-5155
Practice Address - Street 1:4841 KELLER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5912
Practice Address - Country:US
Practice Address - Phone:469-848-7376
Practice Address - Fax:214-261-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory