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General NPI Number Information
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NPI Number | 1013315233
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Entity Type | Organization
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Legal Business Name | HOUSTON PARK PRECISE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 6201 BONHOMME RD STE 408S
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City | HOUSTON
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State | TX
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Zip | 77036-4384
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Country | US
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Telephone | 847-668-7889
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Fax | 224-357-9197
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Provider Business Mailing Address
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Address Line | 6201 BONHOMME RD STE 408S
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City | HOUSTON
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State | TX
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Zip | 77036-4384
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Country | US
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Telephone | 847-668-7889
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Fax | 224-357-9197
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. ANDY STARTSEFF
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Credential |
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Telephone | 847-668-7889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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