Provider Demographics
NPI:1093578551
Name:EMERALD MOLECULAR LABORATORY LLC
Entity Type:Organization
Organization Name:EMERALD MOLECULAR LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-507-9860
Mailing Address - Street 1:7500 W US HIGHWAY 71 STE 105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8200
Mailing Address - Country:US
Mailing Address - Phone:512-647-1091
Mailing Address - Fax:512-777-4052
Practice Address - Street 1:7500 W US HIGHWAY 71 STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8200
Practice Address - Country:US
Practice Address - Phone:512-647-1091
Practice Address - Fax:512-777-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory