Provider Demographics
NPI:1093294746
Name:GRAHAM TOMBALL LLC
Entity Type:Organization
Organization Name:GRAHAM TOMBALL LLC
Other - Org Name:DIAX LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-592-1337
Mailing Address - Street 1:1101 ALMA ST STE 108
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4559
Mailing Address - Country:US
Mailing Address - Phone:281-503-1711
Mailing Address - Fax:
Practice Address - Street 1:1101 ALMA ST STE 104
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4559
Practice Address - Country:US
Practice Address - Phone:281-503-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENTA STATE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-13
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory