Basic Information
| Provider Information | |||||||||
| NPI: | 1992319818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICA'S MEDICAL DIAGNOSTICS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6090 SURETY DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153039215 | ||||||||
| FaxNumber: | 9153039216 | ||||||||
| Practice Location | |||||||||
| Address1: | 6090 SURETY DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153039215 | ||||||||
| FaxNumber: | 9153039216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHAVEZ | ||||||||
| AuthorizedOfficialFirstName: | IVAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 9153039215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.