Provider Demographics
NPI:1962190819
Name:ENCOMPASS DIAGNOSTICS LLC
Entity type:Organization
Organization Name:ENCOMPASS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTEVOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-400-3475
Mailing Address - Street 1:4125 FAIRWAY DR STE 132
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6513
Mailing Address - Country:US
Mailing Address - Phone:469-694-7711
Mailing Address - Fax:469-694-7711
Practice Address - Street 1:4125 FAIRWAY DR STE 132
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6513
Practice Address - Country:US
Practice Address - Phone:972-400-3475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory