Provider Demographics
NPI:1437296175
Name:WILKENFELD MEDICAL LABORATORIES, I, LTD.
Entity Type:Organization
Organization Name:WILKENFELD MEDICAL LABORATORIES, I, LTD.
Other - Org Name:WILKENFELD MEDICAL LABORATORIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WILKENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-468-0738
Mailing Address - Street 1:PO BOX 800967
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77280-0967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8830 LONG POINT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3040
Practice Address - Country:US
Practice Address - Phone:713-464-5326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL0291OtherBCBS
TXCL0291OtherBCBS