Healthcare Provider Details

I. General information

NPI: 1790100493
Provider Name (Legal Business Name): SPIRO STAT TECHNOLOGIES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CLOVIS RD
SHALLOWATER TX
79363-4732
US

IV. Provider business mailing address

503 CLOVIS RD
SHALLOWATER TX
79363-4732
US

V. Phone/Fax

Practice location:
  • Phone: 432-263-1324
  • Fax: 432-263-2124
Mailing address:
  • Phone: 432-263-1324
  • Fax: 432-263-2124

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: KENNETH BOOTH
Title or Position: CEO
Credential: CPA
Phone: 432-263-1324