Provider Demographics
NPI:1467778514
Name:ST. MICHAEL'S LABS SAN ANTONIO, INC
Entity Type:Organization
Organization Name:ST. MICHAEL'S LABS SAN ANTONIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DOC
Authorized Official - Phone:713-586-6705
Mailing Address - Street 1:PO BOX 925185
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-5185
Mailing Address - Country:US
Mailing Address - Phone:713-586-6705
Mailing Address - Fax:713-586-6752
Practice Address - Street 1:18518 HARDY OAK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4759
Practice Address - Country:US
Practice Address - Phone:713-586-6705
Practice Address - Fax:713-586-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801160206291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory