Provider Demographics
NPI:1760461909
Name:PROST DATA, INC.
Entity Type:Organization
Organization Name:PROST DATA, INC.
Other - Org Name:DBA OUR LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-874-0410
Mailing Address - Street 1:PO BOX 291209
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1209
Mailing Address - Country:US
Mailing Address - Phone:615-874-0410
Mailing Address - Fax:615-345-4653
Practice Address - Street 1:1450 ELM HILL PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4531
Practice Address - Country:US
Practice Address - Phone:615-874-0410
Practice Address - Fax:615-345-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44D0949538291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8585Medicare ID - Type Unspecified
TNF80851Medicare UPIN
TN3403583Medicare ID - Type UnspecifiedMEIDCARE NUMBER FOR TN