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General NPI Number Information
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NPI Number | 1720448061
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Entity Type | Organization
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Legal Business Name | CHAMPIONS PLAZA LABORATORIES, L.L.C.
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 305 WELLS FARGO DR STE A4
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City | HOUSTON
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State | TX
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Zip | 77090-4058
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Country | US
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Telephone | 281-397-1271
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Fax | 281-238-5090
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Provider Business Mailing Address
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Address Line | 305 WELLS FARGO DR STE A4
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City | HOUSTON
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State | TX
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Zip | 77090-4058
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Country | US
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Telephone | 281-397-1271
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Fax | 281-238-5090
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Authorized Official
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Title or Position | OWNER
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Name | STACEY GREEN
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Credential |
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Telephone | 713-818-5703
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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 |
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License Number State |
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