Provider Demographics
NPI:1972748424
Name:INFORM DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:INFORM DIAGNOSTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-350-0537
Mailing Address - Street 1:1111 S FREEPORT PKWY
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT/CREDENTIALING
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4435
Mailing Address - Country:US
Mailing Address - Phone:866-588-3280
Mailing Address - Fax:972-767-0225
Practice Address - Street 1:501 N 44TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6535
Practice Address - Country:US
Practice Address - Phone:866-588-3280
Practice Address - Fax:972-767-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ116576Medicare PIN