Provider Demographics
NPI:1023485281
Name:LABORATORY SERVICES OF EAST TEXAS
Entity type:Organization
Organization Name:LABORATORY SERVICES OF EAST TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-630-6400
Mailing Address - Street 1:9301 NORTH CENTRAL EXPRESSWAY
Mailing Address - Street 2:TOWER B 335B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-618-8226
Mailing Address - Fax:214-618-8227
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:TOWER B 335B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-618-8226
Practice Address - Fax:214-618-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2067321291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory