Provider Demographics
NPI:1942609458
Name:OUTSOURCE DIAGNOSTICS LCC
Entity Type:Organization
Organization Name:OUTSOURCE DIAGNOSTICS LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-266-9497
Mailing Address - Street 1:5826 ESPLANADE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4198
Mailing Address - Country:US
Mailing Address - Phone:361-288-1855
Mailing Address - Fax:361-232-5695
Practice Address - Street 1:5826 ESPLANADE DR STE 202
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4198
Practice Address - Country:US
Practice Address - Phone:361-288-1855
Practice Address - Fax:361-232-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic