Provider Demographics
NPI:1689349102
Name:ADVANCED MEDICAL DIAGNOSTICS OF TEXAS, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL DIAGNOSTICS OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-508-6060
Mailing Address - Street 1:333 RESEARCH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:817-526-5380
Mailing Address - Fax:
Practice Address - Street 1:333 RESEARCH CT STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:866-508-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory