Provider Demographics
NPI:1760655294
Name:MAXUM HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:MAXUM HEALTH SERVICES CORP
Other - Org Name:INSIGHT DIAG FOREST LN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & CHIEF ACCOUNTING OFCR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRAZBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:PO BOX 848074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11617 N CENTRAL EXPY
Practice Address - Street 2:MOBILE UNIT
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3800
Practice Address - Country:US
Practice Address - Phone:214-369-3795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXUM HEALTH SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory