Provider Demographics
NPI:1750348926
Name:MAXUM HEALTH SERVICES CORP
Entity type:Organization
Organization Name:MAXUM HEALTH SERVICES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER; TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:PO BOX 848074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8074
Mailing Address - Country:US
Mailing Address - Phone:949-282-6000
Mailing Address - Fax:
Practice Address - Street 1:11617 N CENTRAL EXPY
Practice Address - Street 2:STE 132
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3800
Practice Address - Country:US
Practice Address - Phone:214-369-3795
Practice Address - Fax:214-692-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470000639OtherRAILROAD MEDICARE
TX130085706Medicaid
TXFTA016Medicare PIN