Provider Demographics
NPI:1568781300
Name:PACIFIC LABS, LLC
Entity Type:Organization
Organization Name:PACIFIC LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-435-0242
Mailing Address - Street 1:1000 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-1210
Mailing Address - Country:US
Mailing Address - Phone:940-435-0242
Mailing Address - Fax:940-435-0368
Practice Address - Street 1:1000 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-1210
Practice Address - Country:US
Practice Address - Phone:940-435-0242
Practice Address - Fax:940-435-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL1132OtherMEDICARE