Healthcare Provider Details

I. General information

NPI: 1407046444
Provider Name (Legal Business Name): CISKA LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HOMESTEAD RD SUITE 2
HOUSTON TX
77028-2145
US

IV. Provider business mailing address

5116 BISSONNET ST SUITE 327
BELLAIRE TX
77401-4007
US

V. Phone/Fax

Practice location:
  • Phone: 713-633-0600
  • Fax:
Mailing address:
  • Phone: 713-633-0600
  • 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: BRYAN LIPSEN
Title or Position: GENERAL SUPERVISOR
Credential: M.D.
Phone: 713-635-6996