Provider Demographics
NPI:1790219137
Name:INFORM DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:INFORM DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-309-2674
Mailing Address - Street 1:6655 N MACARTHUR BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPARTMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-596-7031
Mailing Address - Fax:
Practice Address - Street 1:101B VILLA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4653
Practice Address - Country:US
Practice Address - Phone:800-979-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty