Provider Demographics
NPI:1699841221
Name:MICROBIOLOGY SPECIALTY LAB INC
Entity Type:Organization
Organization Name:MICROBIOLOGY SPECIALTY LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-630-9522
Mailing Address - Street 1:3103 CENTER POINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-630-9522
Mailing Address - Fax:956-661-9165
Practice Address - Street 1:3103 CENTER POINTE DRIVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-630-9522
Practice Address - Fax:956-991-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090098702Medicaid
TXCL 8342Medicare ID - Type Unspecified