=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801922893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRL LABS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9425 HEALTHPLEX DR SUITE 101
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71106-8148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-594-2456
-----------------------------------------------------
Fax | 903-594-2438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6640
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75711-6640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-594-2456
-----------------------------------------------------
Fax | 903-594-2438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. TIFFANY LEWIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-594-2456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------