Provider Demographics
NPI:1811376825
Name:MISSION DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MISSION DIAGNOSTICS, LLC
Other - Org Name:A&M HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-372-0397
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-0197
Mailing Address - Country:US
Mailing Address - Phone:888-395-0423
Mailing Address - Fax:888-409-5754
Practice Address - Street 1:10414 ROCKLEY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-3524
Practice Address - Country:US
Practice Address - Phone:281-617-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2054829291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2054829OtherCLIA