Provider Demographics
NPI:1700877701
Name:ITXM DIAGNOSTICS INC
Entity Type:Organization
Organization Name:ITXM DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-209-7151
Mailing Address - Street 1:3636 BOULEVARD OF THE ALLIES
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-209-7329
Mailing Address - Fax:412-209-7325
Practice Address - Street 1:3636 BOULEVARD OF THE ALLIES
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-209-7329
Practice Address - Fax:412-209-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D0667119291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072871Medicare ID - Type UnspecifiedLAB/COAG
PA072851Medicare ID - Type UnspecifiedDOCTOR SERVICES