Provider Demographics
NPI:1205346954
Name:SELECT DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:SELECT DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERWAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-646-8663
Mailing Address - Street 1:8222 DOUGLAS AVE, STE 820
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225
Mailing Address - Country:US
Mailing Address - Phone:469-646-8663
Mailing Address - Fax:888-252-7043
Practice Address - Street 1:535 E. FERNHURST DR, STE 111
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1431
Practice Address - Country:US
Practice Address - Phone:888-280-6332
Practice Address - Fax:888-252-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty