Provider Demographics
NPI:1386817435
Name:Q MED LABORATORY, LLC
Entity Type:Organization
Organization Name:Q MED LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:OMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-855-2454
Mailing Address - Street 1:11355 MONTWOOD DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3876
Mailing Address - Country:US
Mailing Address - Phone:915-855-2454
Mailing Address - Fax:
Practice Address - Street 1:11355 MONTWOOD DR
Practice Address - Street 2:SUITE E
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3876
Practice Address - Country:US
Practice Address - Phone:915-855-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1081814291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory