Provider Demographics
NPI:1225644958
Name:XYZ MOLECULAR DIAGNOSTIC LAB CONSULTING
Entity Type:Organization
Organization Name:XYZ MOLECULAR DIAGNOSTIC LAB CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEQIN
Authorized Official - Middle Name:YANG
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-584-7589
Mailing Address - Street 1:1502 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3722
Mailing Address - Country:US
Mailing Address - Phone:512-584-7589
Mailing Address - Fax:
Practice Address - Street 1:2009 RANCH ROAD 620 N SUITE 325
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2601
Practice Address - Country:US
Practice Address - Phone:512-584-7589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory