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General NPI Number Information
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NPI Number | 1427857440
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Entity Type | Organization
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Legal Business Name | DIRECT DIAGNOSTIC LABORATORY LLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 9900 WESTPARK DR STE 355
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City | HOUSTON
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State | TX
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Zip | 77063-5377
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Country | US
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Telephone | 404-435-9685
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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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 | RICHARD ELLIOTT
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Credential |
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Telephone | 404-435-9685
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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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