MEDICARE: COVIDTESTINGTEXASLLC

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	:	1528715927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVIDTESTINGTEXASLLC

Provider Business Mailing Address
First Line	:	25414 SKYE SPRINGS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-2973
Country	:	US
Telephone Number	:	832-853-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	3222 HILLCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5806
Country	:	US
Telephone Number	:	832-853-0855
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AFRAS ASHFAQ WADIWALA
Credential	:
Telephone Number	:	832-853-0855

Provider Enumeration Date	:	03/05/2022
Last Update Date	:	05/19/2022

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Directions to “COVIDTESTINGTEXASLLC ” Practice Location

Language	Start Address	Practice Location

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