Organization
ACTIVE DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY GRAY (EXECUTIVE VICE PRESIDENT, CFO AND C)
(800) 348-4565
Entity
Organization
Contact information
Practice address
3 MARYLAND FARMS STE 200, BRENTWOOD, TN 37027-5005
(800) 348-4565
(615) 345-5405
Mailing address
3 MARYLAND FARMS STE 200, BRENTWOOD, TN 37027-5005
(800) 348-4565
(615) 345-5405
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ0521Z
BLUE SHIELD
CA
Enumeration date
10/25/2006
Last updated
07/20/2018
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