Healthcare Provider Details

I. General information

NPI: 1427718105
Provider Name (Legal Business Name): KOAR MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 LILAC LN
DESOTO TX
75115-1465
US

IV. Provider business mailing address

508 LILAC LN
DESOTO TX
75115-1465
US

V. Phone/Fax

Practice location:
  • Phone: 972-921-9481
  • Fax:
Mailing address:
  • Phone: 972-921-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHLEY MCDANIELS
Title or Position: OWNER
Credential:
Phone: 972-921-9481