MEDICARE: BIOPSY STAT

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	:	1619351566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOPSY STAT

Provider Business Mailing Address
First Line	:	2102 SHADOWBRIAR DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6013
Country	:	US
Telephone Number	:	214-422-9416
Fax Number	:	832-962-8788

Provider Business Practice Location Address
First Line	:	3030 S GESSNER RD STE 270
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3765
Country	:	US
Telephone Number	:	214-422-6416
Fax Number	:	832-962-8788

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. EMMA DIAZ DE LEON
Credential	:	M.D.
Telephone Number	:	214-422-9416

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	07/09/2015

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