=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881850642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS BIOMEDICAL LAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2008
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13921 OLD CHOCOLATE BAYOU RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77048-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-776-3266
-----------------------------------------------------
Fax | 713-609-9185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13921 OLD CHOCOLATE BAYOU RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77048-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-776-3266
-----------------------------------------------------
Fax | 713-609-9185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DEVENDRA NATH SRIVASTVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-776-3266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D0675026
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------