Provider Demographics
NPI:1508828773
Name:IN-VITRO DIAGNOSTICS INC
Entity Type:Organization
Organization Name:IN-VITRO DIAGNOSTICS INC
Other - Org Name:SEROLAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-246-9000
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-0400
Mailing Address - Country:US
Mailing Address - Phone:512-246-9000
Mailing Address - Fax:
Practice Address - Street 1:7100 OLD MCGREGOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6120
Practice Address - Country:US
Practice Address - Phone:512-246-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0659993291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002165800Medicaid
TX025301501Medicaid
IN200507540AMedicaid
OK100758840AMedicaid
AL000458394Medicaid
KY37902731Medicaid
TXCLO394OtherBCBS OF TX PPO
IA0924639Medicaid
MS00112935Medicaid
OH0898613Medicaid
KY1066360Medicaid
KS100245010AMedicaid
AR115149709Medicaid
SD5581210Medicaid
GA000461689AMedicaid
WY105647600Medicaid
KY37902731Medicaid
NE=========00Medicaid
TX690007174Medicare PIN