Provider Demographics
NPI:1710171384
Name:CITY CLINICAL LAB
Entity Type:Organization
Organization Name:CITY CLINICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB.MANAGER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:AKHIGBE
Authorized Official - Last Name:SANAMI
Authorized Official - Suffix:
Authorized Official - Credentials:BS CHEMISTRY
Authorized Official - Phone:713-771-9994
Mailing Address - Street 1:6300 HILLCROFT AVE
Mailing Address - Street 2:SUITE 100 B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3005
Mailing Address - Country:US
Mailing Address - Phone:713-771-9994
Mailing Address - Fax:713-771-9996
Practice Address - Street 1:6300 HILLCROFT AVE
Practice Address - Street 2:SUITE 100 B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3005
Practice Address - Country:US
Practice Address - Phone:718-484-8708
Practice Address - Fax:713-484-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1044915291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177274101Medicaid
TX01175282OtherAMERIGROUP NO.
TX177274101Medicaid
TXCL8606Medicare PIN