Provider Demographics
NPI:1710936919
Name:MEDICAL EXERCISE TESTING SERVICE, INC.
Entity Type:Organization
Organization Name:MEDICAL EXERCISE TESTING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-539-4427
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-0874
Mailing Address - Country:US
Mailing Address - Phone:281-346-0801
Mailing Address - Fax:281-346-0802
Practice Address - Street 1:3700 FORUMS DR
Practice Address - Street 2:SUITE 112
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1820
Practice Address - Country:US
Practice Address - Phone:972-539-4427
Practice Address - Fax:972-874-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007260397OtherAETNA
TX8P0250OtherBLUE CROSS HMO
TXAS10466580001OtherCIGNA
TX00000092LMOtherBLUE CROSS/BLUE SHIELD
TX=========001OtherTRICARE
TX8P0250OtherBLUE CROSS HMO
TX========= 0002OtherCIGNA
TX=========001OtherTRICARE