Provider Demographics
NPI:1629486659
Name:PREMIER HISTOLOGY OF TEXAS LLC
Entity Type:Organization
Organization Name:PREMIER HISTOLOGY OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KVAPIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-377-7210
Mailing Address - Street 1:PO BOX 540088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-0088
Mailing Address - Country:US
Mailing Address - Phone:713-850-1190
Mailing Address - Fax:713-850-1327
Practice Address - Street 1:4560 BELT LINE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4505
Practice Address - Country:US
Practice Address - Phone:214-377-7210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty