Provider Demographics
NPI:1689639544
Name:HEALTHTRACKRX INDIANA, INC
Entity Type:Organization
Organization Name:HEALTHTRACKRX INDIANA, INC
Other - Org Name:HEALTHTRACKRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-444-7701
Mailing Address - Street 1:1500 INTERSTATE 35 W
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-2402
Mailing Address - Country:US
Mailing Address - Phone:940-383-2223
Mailing Address - Fax:214-975-2717
Practice Address - Street 1:1500 INTERSTATE 35 W
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-2402
Practice Address - Country:US
Practice Address - Phone:940-383-2223
Practice Address - Fax:940-383-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
291U00000X
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID100132790AMedicaid
IN15D0647225OtherCLIA
TX45D2009077OtherCLIA
IN100132790AMedicaid
983380Medicare PIN