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PROMUS DIAGNOSTICS LLC NPI 1033680681


NPI Information

NPI: 1033680681
Provider Name: PROMUS DIAGNOSTICS, LLC
Classification: Clinical Medical Laboratory - 291U00000X
Entity Type: Organization

CLIA Number: 45D2156626

Address:
525 S KIMBALL AVE
SOUTHLAKE, TX
ZIP 76092
Phone: (817) 778-9210
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PROMUS DIAGNOSTICS, LLC is a clinical medical laboratory in Southlake, TX. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. PROMUS DIAGNOSTICS, LLC NPI is 1033680681. The provider is registered as an organization entity type.

The provider's business location address is:

525 S KIMBALL AVE
SOUTHLAKE, TX
ZIP 76092-064
Phone: (817) 778-9210
Fax: (817) 778-9244

The provider's authorized official is Ty Bruggmann .
The authorized official title is Ceo and has the following contact phone number (214) 924-0194.

The CLIA number assigned to this NPI record is 45D2156626 - independent with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 12/7/2018 and was last updated on 10/10/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1291U00000XClinical Medical LaboratoryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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