Provider Demographics
NPI:1497001234
Name:ROBIN JOHNSON
Entity Type:Organization
Organization Name:ROBIN JOHNSON
Other - Org Name:STAT LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-906-5507
Mailing Address - Street 1:1515 KELLETT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-2251
Mailing Address - Country:US
Mailing Address - Phone:512-906-5507
Mailing Address - Fax:512-334-9900
Practice Address - Street 1:7901 CAMERON RD
Practice Address - Street 2:BLDG 3 SUITE 326
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-3831
Practice Address - Country:US
Practice Address - Phone:512-906-5507
Practice Address - Fax:512-334-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2043244291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory