Provider Demographics
NPI:1508144148
Name:TOTAL CARE LABORATORY LLC
Entity Type:Organization
Organization Name:TOTAL CARE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-9135
Mailing Address - Street 1:9707 HARPERS LN APT 445
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5754
Mailing Address - Country:US
Mailing Address - Phone:941-914-8286
Mailing Address - Fax:
Practice Address - Street 1:17300 DALLAS PKWY STE 3010
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-7710
Practice Address - Country:US
Practice Address - Phone:972-532-0151
Practice Address - Fax:972-532-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49D2025312291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2025312OtherCLINICAL LABORATORY IMPROVEMENT AMENDMENTS