Provider Demographics
NPI:1629065362
Name:T.H.A.T. LAB INC.
Entity Type:Organization
Organization Name:T.H.A.T. LAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:254-694-3515
Mailing Address - Street 1:2385 HWY 22
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692
Mailing Address - Country:US
Mailing Address - Phone:254-694-3515
Mailing Address - Fax:254-694-3585
Practice Address - Street 1:2385 STATE HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-3573
Practice Address - Country:US
Practice Address - Phone:254-694-3515
Practice Address - Fax:254-694-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065650332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16937902Medicaid
TX4817580001Medicare NSC