Provider Demographics
NPI:1477164697
Name:HILLCREST LABORATORY SERVICES LLC
Entity Type:Organization
Organization Name:HILLCREST LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMECHI-OBIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-552-2530
Mailing Address - Street 1:1015 HILLCREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3165
Mailing Address - Country:US
Mailing Address - Phone:940-552-2530
Mailing Address - Fax:940-552-2539
Practice Address - Street 1:1015 HILLCREST DR STE A
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3165
Practice Address - Country:US
Practice Address - Phone:940-552-2530
Practice Address - Fax:940-552-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory