Provider Demographics
NPI:1023846169
Name:TEXAS CLINICAL LABORATORY LLC
Entity type:Organization
Organization Name:TEXAS CLINICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-705-2301
Mailing Address - Street 1:6130 MONTANA AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2047
Mailing Address - Country:US
Mailing Address - Phone:512-768-5058
Mailing Address - Fax:254-765-2267
Practice Address - Street 1:6130 MONTANA AVE STE 217
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2047
Practice Address - Country:US
Practice Address - Phone:512-768-5058
Practice Address - Fax:254-765-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory