Provider Demographics
NPI:1033533856
Name:HEALTHCORE LABORATORIES
Entity Type:Organization
Organization Name:HEALTHCORE LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-730-4450
Mailing Address - Street 1:7988 W VIRGINIA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3764
Mailing Address - Country:US
Mailing Address - Phone:214-730-4450
Mailing Address - Fax:214-730-4457
Practice Address - Street 1:7988 W VIRGINIA DR STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3764
Practice Address - Country:US
Practice Address - Phone:214-618-5600
Practice Address - Fax:214-618-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1073121OtherCLIA
TX45D2043946OtherCLIA