Provider Demographics
NPI:1093869489
Name:ANDRE LABORATORY INC
Entity Type:Organization
Organization Name:ANDRE LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:RMT
Authorized Official - Phone:915-328-6318
Mailing Address - Street 1:1570 LOMALAND
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935
Mailing Address - Country:US
Mailing Address - Phone:915-328-6318
Mailing Address - Fax:915-857-0492
Practice Address - Street 1:1570 LOMALAND
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935
Practice Address - Country:US
Practice Address - Phone:915-328-6318
Practice Address - Fax:915-857-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1616120Medicaid
TX0000CL5123OtherBLUE CROSS BLUE SHIELD TX
TX1616120Medicaid