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General NPI Number Information
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NPI Number | 1033602560
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Entity Type | Organization
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Legal Business Name | TGB LABS LLC
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Dates
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Enumeration Date | 06/09/2018
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Last Update Date | 06/09/2018
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Provider Practice Location Address
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Address Line | 1420 ROBINSON RD STE 120A
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City | CORINTH
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State | TX
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Zip | 76210-2848
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Country | US
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Telephone | 940-227-4631
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 ROBINSON RD STE 120A
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City | CORINTH
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State | TX
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Zip | 76210-2848
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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 | CFO
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Name | PAVIN JACOB
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Credential |
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Telephone | 214-208-6870
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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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