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General NPI Number Information
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NPI Number | 1174013288
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Entity Type | Organization
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Legal Business Name | MEDI-LAB PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1307 S 10TH ST STE 2
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City | MCALLEN
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State | TX
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Zip | 78501-5023
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Country | US
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Telephone | 956-800-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 605 S 10TH ST STE B
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City | MCALLEN
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State | TX
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Zip | 78501-4967
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Country | US
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Telephone | 956-800-5008
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Fax | 956-800-5311
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRENDA SELENE PEREZ
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Credential |
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Telephone | 956-360-7889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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