Provider Demographics
NPI:1790100493
Name:SPIRO STAT TECHNOLOGIES, LP
Entity Type:Organization
Organization Name:SPIRO STAT TECHNOLOGIES, LP
Other - Org Name:KS3 LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:432-263-1324
Mailing Address - Street 1:503 CLOVIS RD
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-4732
Mailing Address - Country:US
Mailing Address - Phone:432-263-1324
Mailing Address - Fax:432-263-2124
Practice Address - Street 1:503 CLOVIS RD
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-4732
Practice Address - Country:US
Practice Address - Phone:432-263-1324
Practice Address - Fax:432-263-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory