Healthcare Provider Details

I. General information

NPI: 1568877124
Provider Name (Legal Business Name): BEST LAB SERVICE PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W WALNUT HILL LN #158
IRVING TX
75038-3000
US

IV. Provider business mailing address

1300 W WALNUT HILL LN #158
IRVING TX
75038-3000
US

V. Phone/Fax

Practice location:
  • Phone: 469-777-4669
  • Fax: 467-777-4529
Mailing address:
  • Phone: 469-777-4669
  • Fax: 467-777-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D2076856
License Number StateTX

VIII. Authorized Official

Name: MR. RAVI MORISETTY
Title or Position: OWNER
Credential:
Phone: 469-777-4669