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General NPI Number Information
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NPI Number | 1407111024
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CLINICAL LABORATORY LLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 9301 NORTH CENTRAL EXPRESSWAY TOWER 2 SUITE 335A
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City | DALLAS
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State | TX
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Zip | 75231
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Country | US
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Telephone | 972-630-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 9301 NORTH CENTRAL EXPRESSWAY TOWER 2 SUITE 335A
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City | DALLAS
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State | TX
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Zip | 75231
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Country | US
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Telephone | 972-630-6400
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Fax |
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Authorized Official
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Title or Position | VP OF COMPLIANCE
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Name | MR. DEAN VISKOVICH
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Credential |
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Telephone | 972-630-6400
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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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