Provider Demographics
NPI:1922017516
Name:INSTANT DIAGNOSTIC SYSTEMS, INC.
Entity Type:Organization
Organization Name:INSTANT DIAGNOSTIC SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-355-0691
Mailing Address - Street 1:1740 4TH AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5900
Mailing Address - Country:US
Mailing Address - Phone:800-355-0691
Mailing Address - Fax:734-843-7719
Practice Address - Street 1:1740 4TH AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5900
Practice Address - Country:US
Practice Address - Phone:800-355-0691
Practice Address - Fax:734-843-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory