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General NPI Number Information
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NPI Number | 1013678333
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Entity Type | Organization
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Legal Business Name | US LAB HOLDINGS LLC
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Dates
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Enumeration Date | 01/08/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 2500 E TC JESTER BLVD STE 201
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City | HOUSTON
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State | TX
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Zip | 77008-1458
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Country | US
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Telephone | 816-309-0569
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Fax |
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Provider Business Mailing Address
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Address Line | 10132 SHORE PINE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89129-8174
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Country | US
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Telephone | 816-309-0569
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. VINCENT VITATOE
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Credential |
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Telephone | 816-309-0569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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