Provider Demographics
NPI:1720593031
Name:PERSONAL LAB SERVICES INC
Entity Type:Organization
Organization Name:PERSONAL LAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-800-5638
Mailing Address - Street 1:7447 HARWIN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7447 HARWIN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2016
Practice Address - Country:US
Practice Address - Phone:713-800-5638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty