=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558883355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALLUX LABORATORIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2017
-----------------------------------------------------
Last Update Date | 07/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2809 MILLER RANCH RD STE 441
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-9726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-319-4910
-----------------------------------------------------
Fax | 832-663-9371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 719 SAWDUST RD STE 213
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-319-4910
-----------------------------------------------------
Fax | 832-663-9371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | PHIL SANCHEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-319-4910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------