MEDICARE: LABGEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1124708532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABGEN

Provider Business Mailing Address
First Line	:	450 N SAM HOUSTON PKWY E STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3552
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 N SAM HOUSTON PKWY E STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3552
Country	:	US
Telephone Number	:	281-372-6107
Fax Number	:	678-999-8218

Authorized Official
Title or Position	:	OWNER
Name	:	MIRZA AHMED
Credential	:	MD
Telephone Number	:	281-372-6107

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	10/05/2023

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