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General NPI Number Information
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NPI Number | 1629486659
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Entity Type | Organization
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Legal Business Name | PREMIER HISTOLOGY OF TEXAS LLC
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 4560 BELT LINE RD SUITE 405
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City | ADDISON
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State | TX
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Zip | 75001-4505
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Country | US
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Telephone | 214-377-7210
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 540088
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City | HOUSTON
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State | TX
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Zip | 77254-0088
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Country | US
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Telephone | 713-850-1190
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Fax | 713-850-1327
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Authorized Official
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Title or Position | MEMBER
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Name | PETER KVAPIL
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Credential | MD
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Telephone | 214-377-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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