Provider Demographics
NPI:1386911246
Name:OVERNIGHT DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:OVERNIGHT DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEDIDSION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-496-1010
Mailing Address - Street 1:10700 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4768
Mailing Address - Country:US
Mailing Address - Phone:800-496-1010
Mailing Address - Fax:
Practice Address - Street 1:10700 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4768
Practice Address - Country:US
Practice Address - Phone:800-496-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386911246Medicare NSC