Provider Demographics
NPI:1417182049
Name:LAP BAND SOLUTIONS CENTER FOR DIAGNOSTICS
Entity Type:Organization
Organization Name:LAP BAND SOLUTIONS CENTER FOR DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYASEELAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-716-9991
Mailing Address - Street 1:7920 BELT LINE RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8145
Mailing Address - Country:US
Mailing Address - Phone:972-716-9991
Mailing Address - Fax:972-716-9994
Practice Address - Street 1:7920 BELT LINE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8145
Practice Address - Country:US
Practice Address - Phone:972-716-9991
Practice Address - Fax:972-716-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09511305S00000X
TX693695305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service