Provider Demographics
NPI:1023161718
Name:EMPIRE CLINICAL LABORATORY, INC.
Entity type:Organization
Organization Name:EMPIRE CLINICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MKRTICH
Authorized Official - Middle Name:
Authorized Official - Last Name:YEPREMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-651-9200
Mailing Address - Street 1:2101 CRAWFORD ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8942
Mailing Address - Country:US
Mailing Address - Phone:713-651-9200
Mailing Address - Fax:
Practice Address - Street 1:2101 CRAWFORD ST
Practice Address - Street 2:SUITE 211
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8942
Practice Address - Country:US
Practice Address - Phone:713-615-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188363901Medicaid
TXCL8658Medicare PIN