Provider Demographics
NPI:1700234267
Name:TRUFIDE DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:TRUFIDE DIAGNOSTICS, LLC
Other - Org Name:TRUFIDE LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-823-9350
Mailing Address - Street 1:580 COMMERCE ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9155
Mailing Address - Country:US
Mailing Address - Phone:972-823-9350
Mailing Address - Fax:972-812-0802
Practice Address - Street 1:580 COMMERCE ST
Practice Address - Street 2:SUITE 180
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9155
Practice Address - Country:US
Practice Address - Phone:972-823-9350
Practice Address - Fax:972-812-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2108334291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory