Provider Demographics
NPI:1144952631
Name:DIAGNOSTIC CENTERS FOR HEALTH INITIATIVES
Entity type:Organization
Organization Name:DIAGNOSTIC CENTERS FOR HEALTH INITIATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DERHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-432-4448
Mailing Address - Street 1:8400 NORMANDALE LAKE BLVD STE 920
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3843
Mailing Address - Country:US
Mailing Address - Phone:844-432-4448
Mailing Address - Fax:844-432-4448
Practice Address - Street 1:601 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1549
Practice Address - Country:US
Practice Address - Phone:844-432-4448
Practice Address - Fax:844-432-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory