Provider Demographics
NPI:1366808388
Name:PRISMHEALTHDX, INC.
Entity type:Organization
Organization Name:PRISMHEALTHDX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:POGORZELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-532-7092
Mailing Address - Street 1:4115 FREIDRICH LN STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-1043
Mailing Address - Country:US
Mailing Address - Phone:800-532-7092
Mailing Address - Fax:512-623-4950
Practice Address - Street 1:4115 FREIDRICH LN STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-1043
Practice Address - Country:US
Practice Address - Phone:800-532-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2008896291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory