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General NPI Number Information
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NPI Number | 1134793946
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Entity Type | Organization
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Legal Business Name | LAB TEST DX, LLC
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 200 CHISHOLM PL STE 107
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City | PLANO
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State | TX
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Zip | 75075-6939
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Country | US
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Telephone | 860-833-0489
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Fax |
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Provider Business Mailing Address
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Address Line | 404 FIRE OPAL LN
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-6451
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Country | US
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Telephone | 860-833-0489
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHNATHAN HAROL
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Credential |
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Telephone | 860-833-0489
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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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