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General NPI Number Information
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NPI Number | 1225913759
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Entity Type | Organization
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Legal Business Name | CENTRA DIAGNOSTICS - TEXAS LLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 10601 CLARENCE DR STE 250
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City | FRISCO
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State | TX
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Zip | 75033-3867
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 5656 BEE CAVES RD STE M300
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL WELCH
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Credential |
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Telephone | 310-625-1309
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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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