Provider Demographics
NPI:1043541923
Name:SAN ANTONIO LABORATORIES INC
Entity Type:Organization
Organization Name:SAN ANTONIO LABORATORIES INC
Other - Org Name:MEDLAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-247-9691
Mailing Address - Street 1:1777 NE LOOP 410
Mailing Address - Street 2:STE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5209
Mailing Address - Country:US
Mailing Address - Phone:210-247-9691
Mailing Address - Fax:210-579-1484
Practice Address - Street 1:211 N LOOP 1604 E
Practice Address - Street 2:STE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1237
Practice Address - Country:US
Practice Address - Phone:210-247-9691
Practice Address - Fax:210-579-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-16
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0501594291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory