MEDICARE: TDM LABORATORIES OF KATY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1821446550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TDM LABORATORIES OF KATY, LLC

Provider Business Mailing Address
First Line	:	5510 ABRAMS RD STE 119B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD STE 119B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:	469-424-1353
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ROBERT MENDEZ
Credential	:
Telephone Number	:	469-424-1353

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	10/26/2022

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