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General NPI Number Information
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NPI Number | 1417627308
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Entity Type | Organization
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Legal Business Name | MDX DIAGNOSTICS LABORATORY
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 6201 BONHOMME RD STE 410S
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City | HOUSTON
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State | TX
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Zip | 77036-4386
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Country | US
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Telephone | 832-372-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 BONHOMME RD STE 410S
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City | HOUSTON
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State | TX
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Zip | 77036-4386
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Country | US
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Telephone | 832-372-9971
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | NAISHADH PANCHAL
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Credential |
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Telephone | 832-372-9971
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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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