Provider Demographics
NPI:1790431930
Name:PUSH MEDICAL SERVICES & LABORATORY
Entity Type:Organization
Organization Name:PUSH MEDICAL SERVICES & LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-439-4608
Mailing Address - Street 1:168 COL ETHEREDGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4224
Mailing Address - Country:US
Mailing Address - Phone:936-439-4608
Mailing Address - Fax:936-353-0055
Practice Address - Street 1:168 COL ETHEREDGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4224
Practice Address - Country:US
Practice Address - Phone:936-439-4608
Practice Address - Fax:936-353-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUSH MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty