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General NPI Number Information
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NPI Number | 1053610220
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Entity Type | Organization
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Legal Business Name | MEGA CLINICAL LAB, INC
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Dates
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Enumeration Date | 03/26/2011
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Last Update Date | 03/26/2011
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Provider Practice Location Address
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Address Line | 7457 HARWIN DR SUITE 149
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City | HOUSTON
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State | TX
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Zip | 77036-2018
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Country | US
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Telephone | 281-822-1222
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Fax | 281-822-1220
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Provider Business Mailing Address
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Address Line | 7457 HARWIN DR SUITE 149
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City | HOUSTON
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State | TX
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Zip | 77036-2018
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Country | US
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Telephone | 281-822-1222
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Fax | 281-822-1220
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIK VARTANYAN
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Credential |
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Telephone | 281-822-1222
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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 | 45D2019859
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License Number State | TX
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