Provider Demographics
NPI:1609316132
Name:ABS LABS LLC
Entity Type:Organization
Organization Name:ABS LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-469-4652
Mailing Address - Street 1:1600 WALLACE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-8006
Mailing Address - Country:US
Mailing Address - Phone:972-241-1388
Mailing Address - Fax:972-893-3403
Practice Address - Street 1:1600 WALLACE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-8006
Practice Address - Country:US
Practice Address - Phone:972-241-1388
Practice Address - Fax:972-893-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1100319OtherCLIA