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General NPI Number Information
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NPI Number | 1629446059
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Entity Type | Organization
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Legal Business Name | DISCOVERY LABORATORY LLC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 10851 MILLER RD SUITE B
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City | DALLAS
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State | TX
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Zip | 75238-1315
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Country | US
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Telephone | 972-373-4411
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Fax | 972-373-4412
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Provider Business Mailing Address
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Address Line | PO BOX 551849
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City | DALLAS
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State | TX
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Zip | 75355-1849
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Country | US
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Telephone | 972-373-4411
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Fax | 972-373-4412
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Authorized Official
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Title or Position | CEO
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Name | MR. KEVIN JONES
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Credential |
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Telephone | 830-237-9702
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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 | 802128493
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License Number State | TX
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