Healthcare Provider Details

I. General information

NPI: 1831541432
Provider Name (Legal Business Name): ESA DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEST LOOP S SUITE 1200
HOUSTON TX
77027-3515
US

IV. Provider business mailing address

2100 WEST LOOP S SUITE 1200
HOUSTON TX
77027-3515
US

V. Phone/Fax

Practice location:
  • Phone: 713-877-0600
  • Fax: 713-877-0602
Mailing address:
  • Phone: 713-877-0600
  • Fax: 713-877-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL B YARBROUGH
Title or Position: PRESIDENT
Credential:
Phone: 713-877-0600