Provider Demographics
NPI:1679744098
Name:BCM CLINIC LAB
Entity Type:Organization
Organization Name:BCM CLINIC LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-798-1127
Mailing Address - Street 1:6620 MAIN ST
Mailing Address - Street 2:SUITE 1275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2348
Mailing Address - Country:US
Mailing Address - Phone:713-798-2313
Mailing Address - Fax:
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 11D.23
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory