Provider Demographics
NPI:1871101808
Name:ADVANCED DIAGNOSTIC LABORATORY
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SWITZER
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:210-982-4000
Mailing Address - Street 1:1077 CENTRAL PKWY S STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5034
Mailing Address - Country:US
Mailing Address - Phone:210-982-4000
Mailing Address - Fax:210-982-4001
Practice Address - Street 1:1077 CENTRAL PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5034
Practice Address - Country:US
Practice Address - Phone:210-982-4000
Practice Address - Fax:210-982-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory