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General NPI Number Information
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NPI Number | 1023422698
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Entity Type | Organization
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Legal Business Name | LABORATORY SERVICES OF EAST TEXAS
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 9301 N CENTRAL EXPY SUITE 335B
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City | DALLAS
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State | TX
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Zip | 75231-0806
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Country | US
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Telephone | 214-618-8226
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Fax | 214-618-8227
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Provider Business Mailing Address
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Address Line | 100 CRESCENT CT SUITE 445
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City | DALLAS
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State | TX
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Zip | 75201-6900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF LABORATORY OPERATIONS
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Name | MS. SANDY BUBERT
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Credential | B.S. ASCP
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Telephone | 214-618-8226
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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 | 45D2067321
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License Number State | TX
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