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General NPI Number Information
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NPI Number | 1902931207
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Entity Type | Organization
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Legal Business Name | STAT DIAGNOSTIC LAB LLC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 509 N HAMPTON RD SUITE 204
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City | DESOTO
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State | TX
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Zip | 75115-4970
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Country | US
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Telephone | 972-230-2323
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Fax | 972-230-2324
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Provider Business Mailing Address
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Address Line | 4515 COLONIAL AVE
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City | DALLAS
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State | TX
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Zip | 75215-4140
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Country | US
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Telephone | 214-434-4032
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DELIA DELORES BOOKER
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Credential |
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Telephone | 214-434-4032
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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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