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General NPI Number Information
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NPI Number | 1457009995
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Entity Type | Organization
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Legal Business Name | RESERVE DIAGNOSTIC LAB
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 2010S SE 1ST ST
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City | MINERAL WELLS
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State | TX
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Zip | 76067-5605
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Country | US
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Telephone | 844-257-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 9032 TYNE TRL
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City | FORT WORTH
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State | TX
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Zip | 76118-7501
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Country | US
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Telephone | 844-257-3737
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | CHANDRESH PATEL
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Credential |
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Telephone | 713-443-8523
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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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