Provider Demographics
NPI:1053480814
Name:MEDPLEX LABORATORIES
Entity Type:Organization
Organization Name:MEDPLEX LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-7823
Mailing Address - Street 1:7271 WURZBACH RD STE 127
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4718
Mailing Address - Country:US
Mailing Address - Phone:210-614-7823
Mailing Address - Fax:210-614-3379
Practice Address - Street 1:7271 WURZBACH RD STE 127
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4718
Practice Address - Country:US
Practice Address - Phone:210-614-7823
Practice Address - Fax:210-614-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL0665Medicare ID - Type Unspecified