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General NPI Number Information
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NPI Number | 1720498876
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Entity Type | Organization
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Legal Business Name | LOTUS LABS
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 1735 KELLER SPRINGS RD STE 210
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City | CARROLLTON
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State | TX
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Zip | 75006-3014
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Country | US
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Telephone | 972-242-5227
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Fax | 972-242-5229
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Provider Business Mailing Address
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Address Line | 1735 KELLER SPRINGS SUITE #210
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City | CARROLLTON
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State | TX
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Zip | 75006
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Country | US
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Telephone | 972-242-5227
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Fax | 972-242-5229
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Authorized Official
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Title or Position | LAB MANAGER
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Name | MRS. BIBY ANCY KURIAN
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Credential |
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Telephone | 214-518-7178
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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 | 45D2072552
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License Number State | TX
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