Provider Demographics
NPI:1578445821
Name:ORIGIN DIAGNOSTICS
Entity type:Organization
Organization Name:ORIGIN DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP INNOVATION
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-502-5695
Mailing Address - Street 1:12574 FLAGLER CENTER BLVD STE 101-63
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2614
Mailing Address - Country:US
Mailing Address - Phone:800-440-6695
Mailing Address - Fax:323-203-1648
Practice Address - Street 1:12574 FLAGLER CENTER BLVD STE 101-63
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2614
Practice Address - Country:US
Practice Address - Phone:800-440-6695
Practice Address - Fax:323-203-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine