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General NPI Number Information
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NPI Number | 1093578551
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Entity Type | Organization
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Legal Business Name | EMERALD MOLECULAR LABORATORY LLC
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 7500 W US HIGHWAY 71 STE 105
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City | AUSTIN
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State | TX
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Zip | 78735-8200
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Country | US
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Telephone | 512-647-1091
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Fax | 512-777-4052
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Provider Business Mailing Address
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Address Line | 7500 W US HIGHWAY 71 STE 105
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City | AUSTIN
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State | TX
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Zip | 78735-8200
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Country | US
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Telephone | 512-647-1091
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Fax | 512-777-4052
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Authorized Official
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Title or Position | OWNER
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Name | ADAM MASTEN
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Credential |
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Telephone | 541-507-9860
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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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