Provider Demographics
NPI:1831494988
Name:EZ DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:EZ DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:BLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:919-780-5900
Mailing Address - Street 1:343 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7949
Mailing Address - Country:US
Mailing Address - Phone:919-780-5900
Mailing Address - Fax:919-780-5905
Practice Address - Street 1:343 TECHNOLOGY DR
Practice Address - Street 2:SUITE 1110
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7949
Practice Address - Country:US
Practice Address - Phone:919-780-5900
Practice Address - Fax:919-780-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34166174400000X, 207R00000X
207RP1001X, 207RS0012X, 261QS1200X
NC0371022084N0400X
NC2084S0012X
NC41252278P1004X
NCA 42482278P1004X
NCA 28552278P1004X
NCA 25592278P1004X
NCA 7252278P1004X
NCA-50472279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Single Specialty
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary DiagnosticsGroup - Single Specialty