Provider Demographics
NPI:1265829204
Name:LAB SOURCE SERVICES
Entity Type:Organization
Organization Name:LAB SOURCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATRONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-265-1752
Mailing Address - Street 1:324 FM 1960 RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1887
Mailing Address - Country:US
Mailing Address - Phone:713-265-1752
Mailing Address - Fax:
Practice Address - Street 1:324 FM 1960 RD STE 101A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1887
Practice Address - Country:US
Practice Address - Phone:713-265-1752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory