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General NPI Number Information
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NPI Number | 1922242577
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Entity Type | Organization
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Legal Business Name | METROSTAT CLINICAL LABORATORY, INC
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 325 GOLD ST 118
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City | GARLAND
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State | TX
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Zip | 75042-6658
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Country | US
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Telephone | 972-205-1144
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Fax | 972-205-1115
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Provider Business Mailing Address
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Address Line | 325 GOLD ST 118
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City | GARLAND
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State | TX
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Zip | 75042-6658
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Country | US
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Telephone | 972-205-1144
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Fax | 972-205-1115
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY FELTS
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Credential |
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Telephone | 972-205-1144
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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 | 45D1098295
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License Number State | TX
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