Provider Demographics
NPI:1295286417
Name:MDCONNECT LLC
Entity type:Organization
Organization Name:MDCONNECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GREVIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-914-8286
Mailing Address - Street 1:17300 DALLAS PKWY STE 3010
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-7710
Mailing Address - Country:US
Mailing Address - Phone:972-532-0151
Mailing Address - Fax:
Practice Address - Street 1:17300 DALLAS PKWY STE 3010
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-7710
Practice Address - Country:US
Practice Address - Phone:972-532-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory