=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558773622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEER DIAGNOSTIC LABORATORY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2014
-----------------------------------------------------
Last Update Date | 05/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4994 HIGHWAY 6 N # 104D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-6902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-345-7685
-----------------------------------------------------
Fax | 281-345-7753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16100 CAIRNWAY DR STE 225
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-345-7685
-----------------------------------------------------
Fax | 281-345-7753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ESTHER N OPARA-EKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-692-8186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D2074901
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------