Healthcare Provider Details

I. General information

NPI: 1306180310
Provider Name (Legal Business Name): DIGESTIVE LABORATORIES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 PRESTON RD 300E
DALLAS TX
75240
US

IV. Provider business mailing address

13601 PRESTON RD 300E
DALLAS TX
75240
US

V. Phone/Fax

Practice location:
  • Phone: 972-432-6550
  • Fax: 214-261-2217
Mailing address:
  • Phone: 972-432-6550
  • Fax: 214-261-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. JOSH DANIEL
Title or Position: CEO
Credential:
Phone: 972-432-6550