Organization
MOD LAB
Active
Parent organization
PROST DATA INC
Other names
Prost Data Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROST DATA INC
Authorized official
DR. JONATHAN OPPENHEIMER (OWNER)
(615) 874-0410
Entity
Organization
Contact information
Practice address
4600 GREENVILLE AVENUE, SUITE 240, DALLAS, TX 75206-5037
(615) 874-0410
Mailing address
PO BOX 291209, NASHVILLE, TN 37229-1209
(615) 874-0410
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D1036151
CLIA
—
Enumeration date
04/07/2009
Last updated
04/07/2009
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