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General NPI Number Information
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NPI Number | 1043677396
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Entity Type | Organization
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Legal Business Name | SM LABS LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 5700 GRANITE PARKWAY SUITE 234
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City | PLANO
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State | TX
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Zip | 75024-6602
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Country | US
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Telephone | 972-349-0014
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 GRANITE PKWY SUITE 234
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City | PLANO
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State | TX
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Zip | 75024-6622
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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 | CEO/PRESIDENT
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Name | PATRICK LYNN
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Credential |
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Telephone | 972-349-0014
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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 | 45D0882276
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License Number State | TX
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