Healthcare Provider Details

I. General information

NPI: 1235600214
Provider Name (Legal Business Name): SVAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 02/11/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 S STONEBRIDGE DR STE 801
MCKINNEY TX
75070-8056
US

IV. Provider business mailing address

3900 S STONEBRIDGE DR STE 801
MCKINNEY TX
75070-8056
US

V. Phone/Fax

Practice location:
  • Phone: 214-817-4221
  • Fax:
Mailing address:
  • Phone: 469-209-6966
  • Fax: 469-857-8608

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: STEPHEN FERGUSUN
Title or Position: OWNER
Credential:
Phone: 214-817-4221