Provider Demographics
NPI:1386189702
Name:CAPTIVA LAB OF TEXAS, LLC.
Entity Type:Organization
Organization Name:CAPTIVA LAB OF TEXAS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-209-1013
Mailing Address - Street 1:1930 HARRISON ST STE 605
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7829
Mailing Address - Country:US
Mailing Address - Phone:754-209-1013
Mailing Address - Fax:954-272-7924
Practice Address - Street 1:10110 W SAM HOUSTON PKWY S STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5153
Practice Address - Country:US
Practice Address - Phone:754-209-1013
Practice Address - Fax:954-272-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory