Provider Demographics
NPI:1578892287
Name:EXPRESS LAB SERVICES, LLC
Entity Type:Organization
Organization Name:EXPRESS LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-740-9369
Mailing Address - Street 1:905 MCCLELLAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-6281
Mailing Address - Country:US
Mailing Address - Phone:956-740-0968
Mailing Address - Fax:956-568-0874
Practice Address - Street 1:905 MCCLELLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-6281
Practice Address - Country:US
Practice Address - Phone:956-740-0968
Practice Address - Fax:956-568-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory