Healthcare Provider Details

I. General information

NPI: 1548814353
Provider Name (Legal Business Name): MPL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W BELLFORT AVE STE 194
HOUSTON TX
77054-5099
US

IV. Provider business mailing address

402 N 5TH ST
LONGVIEW TX
75601-6529
US

V. Phone/Fax

Practice location:
  • Phone: 281-661-1825
  • Fax: 903-757-5003
Mailing address:
  • Phone: 903-758-8511
  • Fax: 903-757-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOTAZ ALBAHRA
Title or Position: PRESIDENT
Credential: MD
Phone: 903-758-8511