Provider Demographics
NPI:1841741741
Name:ZENITH LABORATORY SERVICES LLC
Entity Type:Organization
Organization Name:ZENITH LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-301-1180
Mailing Address - Street 1:PO BOX 732975
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2975
Mailing Address - Country:US
Mailing Address - Phone:210-301-1180
Mailing Address - Fax:210-877-9695
Practice Address - Street 1:402 N 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6529
Practice Address - Country:US
Practice Address - Phone:903-212-4302
Practice Address - Fax:903-212-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2115273291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
432533OtherMEDICARE PTAN
TX45D2115273OtherCLIA#
TX350469Medicaid