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NPI Code Detail

MEDICARE: EAST TEXAS LABORATORY

MEDICARE: EAST TEXAS LABORATORY
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1730514654
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS LABORATORY
Provider Business Mailing Address
First Line : 125 ARROWHEAD DR
Second Line :
City : GREENVILLE
State : TX
Zip : 75402-3034
Country : US
Telephone Number : 903-268-7381
Fax Number :
Provider Business Practice Location Address
First Line : 106 E MAIN ST
Second Line : SUITE 101
City : ROYSE CITY
State : TX
Zip : 75189-3713
Country : US
Telephone Number : 903-268-7381
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MISS REGINA A PIERCE
Credential :
Telephone Number : 903-268-7381
Provider Enumeration Date : 09/10/2013
Last Update Date : 09/10/2013

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Directions to “EAST TEXAS LABORATORY ” Practice Location

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