Provider Demographics
NPI:1568868446
Name:DTR LABS LLC
Entity Type:Organization
Organization Name:DTR LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:LARKIN
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-901-8144
Mailing Address - Street 1:2150 JUSTIN RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7163
Mailing Address - Country:US
Mailing Address - Phone:469-702-6015
Mailing Address - Fax:469-702-6037
Practice Address - Street 1:2150 JUSTIN RD
Practice Address - Street 2:STE. 300
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7163
Practice Address - Country:US
Practice Address - Phone:866-387-5227
Practice Address - Fax:469-702-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366760201Medicaid
TX554654Medicare PIN