Provider Demographics
NPI:1861865511
Name:PRO HEALTH DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PRO HEALTH DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-339-8919
Mailing Address - Street 1:12639 POND CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0072
Mailing Address - Country:US
Mailing Address - Phone:972-339-8919
Mailing Address - Fax:888-548-2767
Practice Address - Street 1:1925 E BELT LINE RD
Practice Address - Street 2:SUITE 512
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5801
Practice Address - Country:US
Practice Address - Phone:972-339-8919
Practice Address - Fax:888-548-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory