Provider Demographics
NPI:1811646839
Name:NEXTGEN DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:NEXTGEN DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANDA
Authorized Official - Middle Name:ABIGAIL
Authorized Official - Last Name:NUNNELLY-SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-499-1525
Mailing Address - Street 1:407 S PENNSYLVANIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2281
Mailing Address - Country:US
Mailing Address - Phone:417-362-6398
Mailing Address - Fax:
Practice Address - Street 1:407 S PENNSYLVANIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2281
Practice Address - Country:US
Practice Address - Phone:417-362-6398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory