Provider Demographics
NPI:1366180325
Name:LUXURIOUS LAB DIAGNOSTICS LLC
Entity type:Organization
Organization Name:LUXURIOUS LAB DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:870-718-6543
Mailing Address - Street 1:1327 EMPIRE CENTRAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4018
Mailing Address - Country:US
Mailing Address - Phone:254-248-8387
Mailing Address - Fax:
Practice Address - Street 1:1327 EMPIRE CENTRAL DR STE 205
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4018
Practice Address - Country:US
Practice Address - Phone:254-248-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1497416549OtherCLINIC