MEDICARE: DEPARTMENT OF STATE HEALTH SERVICES

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		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902824881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF STATE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 149347
Second Line	:	DSHS SOUTH TEXAS LAB/ZZ330/ MC 2004
City	:	AUSTIN
State	:	TX
Zip	:	78714-9347
Country	:	US
Telephone Number	:	512-458-7111
Fax Number	:	512-458-7588

Provider Business Practice Location Address
First Line	:	1301 S RANGERVILLE RD
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-7610
Country	:	US
Telephone Number	:	956-364-8229
Fax Number	:	956-412-9794

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	GRACE KUBIN
Credential	:
Telephone Number	:	512-776-2468

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/12/2026

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Directions to “DEPARTMENT OF STATE HEALTH SERVICES ” Practice Location

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