Provider Demographics
NPI:1679147862
Name:SAM HOUSTON STATE UNIVERSITY, DIAGNOSTIC LABORATORY FOR HUMAN HEALTH
Entity Type:Organization
Organization Name:SAM HOUSTON STATE UNIVERSITY, DIAGNOSTIC LABORATORY FOR HUMAN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KING
Authorized Official - Last Name:HUARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-408-1750
Mailing Address - Street 1:SHSU DIAGNOSTIC LABORATORY FOR HUMAN HEALTH
Mailing Address - Street 2:2424 SAM HOUSTON AVE. STE. B-8 LAB#173B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77341
Mailing Address - Country:US
Mailing Address - Phone:936-294-3788
Mailing Address - Fax:
Practice Address - Street 1:SHSU DIAGNOSTIC LABORATORY FOR HUMAN HEALTH
Practice Address - Street 2:2424 SAM HOUSTON AVE. STE. B-8 LAB#173B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77341
Practice Address - Country:US
Practice Address - Phone:936-294-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAM HOUSTON STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty