Diversified Diagnostics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

DIVERSIFIED DIAGNOSTICS

Practice address

2225 W Southlake Blvd
Suite 124
Southlake, TX 76092-6750

Phone

(817) 879-0962

Fax

(800) 343-8718

NPI assigned

Nov 16, 2010

Last updated

Nov 16, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tina M York

Title

President

Phone

(817) 879-0962

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1073814448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 W SOUTHLAKE BLVD",
            "address_2": "SUITE 124",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926750",
            "telephone_number": "817-879-0962",
            "fax_number": "800-343-8718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 W SOUTHLAKE BLVD",
            "address_2": "SUITE 124",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926750",
            "telephone_number": "817-879-0962",
            "fax_number": "800-343-8718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-879-0962",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisha Diane Diaz
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• Directions Weight Management
• Krystyn Marie Dishaw, DMD, MS
• Curtis M Dixon, LPT
• Soumana Djibo
• Stephanie Rene Dobbins
• Doctx3 PLLC (Direct Orthopedic Care)
• Dana Dodge

• Clinical Medical Laboratory in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.