Provider Demographics
NPI:1093099558
Name:REALTIME LABORATORIES, INC
Entity Type:Organization
Organization Name:REALTIME LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL AND CLIA DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOF
Authorized Official - Middle Name:
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HCLD, F(AAM)
Authorized Official - Phone:972-492-0419
Mailing Address - Street 1:2540 KING ARTHUR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5833
Mailing Address - Country:US
Mailing Address - Phone:972-492-0419
Mailing Address - Fax:972-243-7759
Practice Address - Street 1:4100 FAIRWAY DR STE 600
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6539
Practice Address - Country:US
Practice Address - Phone:972-492-0419
Practice Address - Fax:972-243-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4105744-01Medicaid