Provider Demographics
NPI:1629086772
Name:PULMONARY LABORATORY SERVICES
Entity Type:Organization
Organization Name:PULMONARY LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-520-5743
Mailing Address - Street 1:4040 N CENTRAL EXPY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3147
Mailing Address - Country:US
Mailing Address - Phone:214-520-5743
Mailing Address - Fax:214-520-5786
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-941-1366
Practice Address - Fax:214-942-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX895586OtherBLUE CROSS/BLUE SHIELD
TX081936901Medicaid
TX895586OtherBLUE CROSS/BLUE SHIELD