Provider Demographics
NPI:1083946735
Name:SANDRA POLOE DBA A1 LABORATORY
Entity Type:Organization
Organization Name:SANDRA POLOE DBA A1 LABORATORY
Other - Org Name:A1 LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLOE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PROFESSION
Authorized Official - Phone:713-931-4848
Mailing Address - Street 1:PO BOX 331515
Mailing Address - Street 2:11500 NORTHWEST FREEWAY STE.435
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77233-1515
Mailing Address - Country:US
Mailing Address - Phone:713-931-4848
Mailing Address - Fax:
Practice Address - Street 1:11500 NORTHWEST FWY
Practice Address - Street 2:SUITE 435
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6530
Practice Address - Country:US
Practice Address - Phone:713-931-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1107637291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory