Provider Demographics
NPI:1073227377
Name:TEXAS MEDICAL LAB LLC
Entity Type:Organization
Organization Name:TEXAS MEDICAL LAB LLC
Other - Org Name:TEXAS MEDICAL LAB LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-884-5100
Mailing Address - Street 1:925 N BRYAN BELT LINE RD # 105
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2541
Mailing Address - Country:US
Mailing Address - Phone:972-884-5100
Mailing Address - Fax:972-288-7445
Practice Address - Street 1:925 N BRYAN BELT LINE RD # 105
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2541
Practice Address - Country:US
Practice Address - Phone:972-884-5100
Practice Address - Fax:972-288-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory