Provider Demographics
NPI:1003180027
Name:COMPANION DX REFERENCE LAB, LLC
Entity Type:Organization
Organization Name:COMPANION DX REFERENCE LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-867-6008
Mailing Address - Street 1:10301 STELLA LINK RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5447
Mailing Address - Country:US
Mailing Address - Phone:832-538-1600
Mailing Address - Fax:832-538-1601
Practice Address - Street 1:10301 STELLA LINK RD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5447
Practice Address - Country:US
Practice Address - Phone:832-538-1600
Practice Address - Fax:832-538-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2034771291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory