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General NPI Number Information
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NPI Number | 1255053153
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Entity Type | Organization
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Legal Business Name | ASTRO LABZ PERMIAN BASIN
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 10810 E AUBURN ST
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City | GARDENDALE
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State | TX
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Zip | 79758-4901
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Country | US
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Telephone | 432-202-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 705 W WADLEY AVE STE 210
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City | MIDLAND
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State | TX
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Zip | 79705-5300
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Country | US
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Telephone | 432-202-0321
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | AL BERRY
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Credential |
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Telephone | 323-676-1281
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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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