Provider Demographics
NPI:1760133482
Name:PROTEAN TESTING CENTER
Entity Type:Organization
Organization Name:PROTEAN TESTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JVONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:214-783-0438
Mailing Address - Street 1:1301 E PARKERVILLE RD
Mailing Address - Street 2:STE A8 #1011
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:469-607-9949
Mailing Address - Fax:469-533-5899
Practice Address - Street 1:1408 DUSKY THRUSH ST
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7656
Practice Address - Country:US
Practice Address - Phone:214-783-0438
Practice Address - Fax:469-533-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service