Healthcare Provider Details

I. General information

NPI: 1336178193
Provider Name (Legal Business Name): MEDICAL CENTER LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 FERRIS AVENUE
WAXAHACHIE TX
75165
US

IV. Provider business mailing address

201 FERRIS AVENUE
WAXAHACHIE TX
75165
US

V. Phone/Fax

Practice location:
  • Phone: 972-937-7310
  • Fax: 972-923-7190
Mailing address:
  • Phone: 972-937-7310
  • Fax: 972-923-7190

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: DR. BRETT MCKINNEY THACKER
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD
Phone: 972-937-7310