Healthcare Provider Details

I. General information

NPI: 1275521825
Provider Name (Legal Business Name): HKA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S EDDY ST SUITE C
PECOS TX
79772-6902
US

IV. Provider business mailing address

1010 S. EDDY ST SUITE C
PECOS TX
79772-6902
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-2808
  • Fax: 432-447-3909
Mailing address:
  • Phone: 432-447-2808
  • Fax: 432-447-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D0055406
License Number StateTX

VIII. Authorized Official

Name: MS. IRMA CASTILLO
Title or Position: CFO
Credential:
Phone: 432-447-2808