Provider Demographics
NPI:1528031481
Name:DIAGNOSTIC CLINIC OF HOUSTON LAB
Entity Type:Organization
Organization Name:DIAGNOSTIC CLINIC OF HOUSTON LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-797-9191
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-797-9191
Mailing Address - Fax:713-394-2852
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-797-9191
Practice Address - Fax:713-394-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL0269OtherBC BS
TXCL0269Medicare ID - Type Unspecified