Provider Demographics
NPI:1699180968
Name:DERHEIM, INC
Entity Type:Organization
Organization Name:DERHEIM, INC
Other - Org Name:HEALTHCARE EMPOWERED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DERHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-454-2212
Mailing Address - Street 1:4021 MAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1186
Mailing Address - Country:US
Mailing Address - Phone:888-454-2112
Mailing Address - Fax:612-564-4906
Practice Address - Street 1:590 PARK ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1846
Practice Address - Country:US
Practice Address - Phone:888-454-2112
Practice Address - Fax:612-564-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory