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General NPI Number Information
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NPI Number | 1366999229
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Entity Type | Organization
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Legal Business Name | CCR LABS LLC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1111 MEDICAL PLAZA DR STE 250
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3477
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Country | US
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Telephone | 713-800-6954
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Fax | 888-883-5227
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Provider Business Mailing Address
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Address Line | 2525 ROBINHOOD ST STE 1200
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City | HOUSTON
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State | TX
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Zip | 77005-2573
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Country | US
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Telephone | 713-800-6954
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Fax | 888-883-5227
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RAZAN KHALIFE
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Credential | B.S., M.B.A.
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Telephone | 713-800-6954
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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 | TX
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