Provider Demographics
NPI:1679955140
Name:PROTIX LABORATORY AND MEDICAL GROUP
Entity Type:Organization
Organization Name:PROTIX LABORATORY AND MEDICAL GROUP
Other - Org Name:NEW WAVE LABORATORY SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONNI
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-327-6412
Mailing Address - Street 1:8200 STONEBROOK PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5588
Mailing Address - Country:US
Mailing Address - Phone:903-327-6412
Mailing Address - Fax:
Practice Address - Street 1:8200 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5539
Practice Address - Country:US
Practice Address - Phone:903-327-6412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW WAVE LABORATORY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory