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General NPI Number Information
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NPI Number | 1538130059
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Entity Type | Organization
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Legal Business Name | TXAR 501A CORPORATION
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 5405 PLAZA DR
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City | TEXARKANA
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State | TX
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Zip | 75503-1662
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Country | US
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Telephone | 903-223-5200
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Fax | 903-223-5213
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD STE 400
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City | ADDISON
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State | TX
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Zip | 75001-3676
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Country | US
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Telephone |
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Fax | 610-271-4245
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | EDWARD M KRAMER
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Credential | MD
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Telephone | 610-550-3003
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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 | 45D0482326
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License Number State | TX
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