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General NPI Number Information
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NPI Number | 1184090342
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Entity Type | Organization
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Legal Business Name | FULL SPECTRUM LABORATORIES LLC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 2624 N LOY LAKE RD SUITE B
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City | SHERMAN
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State | TX
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Zip | 75090-2515
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Country | US
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Telephone | 903-487-2248
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Fax | 903-487-2306
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Provider Business Mailing Address
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Address Line | PO BOX 837
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City | HOWE
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State | TX
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Zip | 75459-0837
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Country | US
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Telephone | 903-487-2248
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Fax | 903-487-2306
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Authorized Official
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Title or Position | CFO
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Name | PROF. PRAKASAH KRISHNARAJ
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Credential |
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Telephone | 903-487-2248
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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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