Provider Demographics
NPI:1013974286
Name:MAXUM HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:MAXUM HEALTH SERVICES CORP
Other - Org Name:INSIGHT DIAG PRESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR V.P. & CHIEF ACCOUNTING OFCR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRAZBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:PO BOX 848074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8074
Mailing Address - Country:US
Mailing Address - Phone:949-282-6000
Mailing Address - Fax:
Practice Address - Street 1:17950 PRESTON RD
Practice Address - Street 2:STE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5793
Practice Address - Country:US
Practice Address - Phone:972-931-7979
Practice Address - Fax:972-931-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130085706Medicaid
TX470000905OtherRAILROAD MEDICARE
TX130085706Medicaid