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General NPI Number Information
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NPI Number | 1841505153
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Entity Type | Organization
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Legal Business Name | MEDICUS LABORATORIES, LLC
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 5710 LBJ FREEWAY SUITE 204
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City | DALLAS
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State | TX
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Zip | 75240-6398
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Country | US
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Telephone | 972-386-6399
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Fax | 972-386-6603
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Provider Business Mailing Address
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Address Line | 7809 HANOVER ST
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City | DALLAS
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State | TX
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Zip | 75225-8221
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Country | US
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Telephone | 214-346-9988
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Fax | 214-346-9989
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY LAWRENCE WASSERMAN
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Credential | MD
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Telephone | 214-886-2108
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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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