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General NPI Number Information
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NPI Number | 1962723379
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Entity Type | Organization
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Legal Business Name | SURETEST LABORATORY,LLC
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 4609 COUNTY ROAD 919
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City | CROWLEY
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State | TX
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Zip | 76036-5535
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Country | US
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Telephone | 817-426-9355
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Fax | 817-426-9357
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Provider Business Mailing Address
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Address Line | 4609 COUNTY ROAD 919
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City | CROWLEY
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State | TX
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Zip | 76036-5535
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Country | US
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Telephone | 817-426-9355
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Fax | 817-426-9357
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH CHARLES LUTKA JR.
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Credential |
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Telephone | 817-426-9355
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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 | 45D1092429
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License Number State | TX
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