Provider Demographics
NPI:1558010579
Name:UNITED DIAGNOSTIC LABS
Entity Type:Organization
Organization Name:UNITED DIAGNOSTIC LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PUNIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-518-6583
Mailing Address - Street 1:3601 E 29TH ST STE 14
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3815
Mailing Address - Country:US
Mailing Address - Phone:855-518-6583
Mailing Address - Fax:855-518-6583
Practice Address - Street 1:3601 E 29TH ST STE 14
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3815
Practice Address - Country:US
Practice Address - Phone:855-518-6583
Practice Address - Fax:855-518-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory