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General NPI Number Information
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NPI Number | 1871071506
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Entity Type | Organization
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Legal Business Name | ASSURANCE LABS
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 6009 W PARKER RD # 208
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City | PLANO
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State | TX
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Zip | 75093-8120
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Country | US
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Telephone | 972-439-0126
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Fax | 214-446-6899
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Provider Business Mailing Address
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Address Line | 6009 W PARKER RD # 208
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City | PLANO
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State | TX
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Zip | 75093-8120
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Country | US
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Telephone | 469-757-0114
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DERRICK THOMPSON SR.
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Credential |
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Telephone | 469-757-0114
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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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