Provider Demographics
NPI:1417647819
Name:WESTWATER DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:WESTWATER DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZING OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKMEZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-559-6929
Mailing Address - Street 1:407 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2305
Mailing Address - Country:US
Mailing Address - Phone:713-559-6929
Mailing Address - Fax:
Practice Address - Street 1:407 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2305
Practice Address - Country:US
Practice Address - Phone:713-559-6929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTWATER DIAGNOSTICS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory