Provider Demographics
NPI:1588420053
Name:5IVE STAR DIAGNOSTIC SOLUTIONS LLC
Entity type:Organization
Organization Name:5IVE STAR DIAGNOSTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-300-8331
Mailing Address - Street 1:1015 MONTLIMAR DR STE C5
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1717
Mailing Address - Country:US
Mailing Address - Phone:251-300-8331
Mailing Address - Fax:251-300-8501
Practice Address - Street 1:1015 MONTLIMAR DR STE C5
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1717
Practice Address - Country:US
Practice Address - Phone:251-300-8331
Practice Address - Fax:251-300-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty