Provider Demographics
NPI:1760874796
Name:AMERIHEALTH LABORATORY, LLC
Entity Type:Organization
Organization Name:AMERIHEALTH LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALATNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-821-8736
Mailing Address - Street 1:4225 OFFICE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3628
Mailing Address - Country:US
Mailing Address - Phone:281-620-4880
Mailing Address - Fax:832-201-7397
Practice Address - Street 1:4225 OFFICE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3628
Practice Address - Country:US
Practice Address - Phone:281-620-4880
Practice Address - Fax:832-201-7397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349370201Medicaid