Provider Demographics
NPI:1629080908
Name:UROLITHIASIS LABORATORY INC
Entity Type:Organization
Organization Name:UROLITHIASIS LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-464-8312
Mailing Address - Street 1:9525 KATY FWY
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1407
Mailing Address - Country:US
Mailing Address - Phone:713-464-4333
Mailing Address - Fax:713-464-6546
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 222
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-464-4333
Practice Address - Fax:713-464-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0997031Medicaid
CAXLAB01310Medicaid
WI32916900Medicaid
MT0421434Medicaid
LA1989312Medicaid
MT0421434Medicaid
NE=========00Medicaid
WI32916900Medicaid
LA1989312Medicaid