Provider Demographics
NPI:1558717827
Name:CONCORD LIFE SCIENCES, LLC
Entity Type:Organization
Organization Name:CONCORD LIFE SCIENCES, LLC
Other - Org Name:PRINCIPLE LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-837-8160
Mailing Address - Street 1:2437 BAY AREA BLVD # 504
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1519
Mailing Address - Country:US
Mailing Address - Phone:800-837-8160
Mailing Address - Fax:281-949-8599
Practice Address - Street 1:16840 BUCCANEER LN STE 281
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2562
Practice Address - Country:US
Practice Address - Phone:800-837-8160
Practice Address - Fax:713-681-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory