Provider Demographics
NPI:1912278771
Name:DALLAS IVF1, LLC
Entity Type:Organization
Organization Name:DALLAS IVF1, LLC
Other - Org Name:DALLAS IVF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-297-0027
Mailing Address - Street 1:2840 LEGACY DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6051
Mailing Address - Country:US
Mailing Address - Phone:214-297-0027
Mailing Address - Fax:214-297-0034
Practice Address - Street 1:2840 LEGACY DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6051
Practice Address - Country:US
Practice Address - Phone:214-297-0027
Practice Address - Fax:214-297-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory