=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225318199
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVAL,LLC DBA LABXPRESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2011
-----------------------------------------------------
Last Update Date | 08/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 HIGHWAY 242 SUITE 106B
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77385-4342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-321-5467
-----------------------------------------------------
Fax | 936-321-5468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3708 W DAVIS ST STE I
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-441-2021
-----------------------------------------------------
Fax | 936-441-0737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ALFREDO TINAJERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-212-7807
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D2026535
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------