Provider Demographics
NPI:1629613922
Name:SPACE CITY LABORATORIES
Entity type:Organization
Organization Name:SPACE CITY LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:USMAN
Authorized Official - Last Name:AIJAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-235-5842
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-2045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12440 EMILY CT STE 301
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4539
Practice Address - Country:US
Practice Address - Phone:713-900-2690
Practice Address - Fax:713-900-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-10
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory