Healthcare Provider Details

I. General information

NPI: 1871970285
Provider Name (Legal Business Name): PHR LABORATORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 AIRPORT FWY
RICHLAND HILLS TX
76118-6902
US

IV. Provider business mailing address

7339 AIRPORT FWY
RICHLAND HILLS TX
76118-6902
US

V. Phone/Fax

Practice location:
  • Phone: 817-590-9599
  • Fax: 817-590-9499
Mailing address:
  • Phone: 817-590-9599
  • Fax: 817-590-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD VILLARREAL JR.
Title or Position: DIRECTOR OF LABORATORY SERVICES
Credential: MLT
Phone: 817-590-9599