Provider Demographics
NPI:1417561358
Name:BNB DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:BNB DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-494-3543
Mailing Address - Street 1:350 NURSERY RD STE 3102
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4079
Mailing Address - Country:US
Mailing Address - Phone:346-351-1203
Mailing Address - Fax:
Practice Address - Street 1:350 NURSERY RD STE 3102
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-4079
Practice Address - Country:US
Practice Address - Phone:346-351-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty