Provider Demographics
NPI:1851059588
Name:TEXAS MOLECULAR DIAGNOSTICS LABORATORY
Entity Type:Organization
Organization Name:TEXAS MOLECULAR DIAGNOSTICS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-681-4870
Mailing Address - Street 1:4324 N BELT LINE RD STE C105
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3538
Mailing Address - Country:US
Mailing Address - Phone:319-594-4108
Mailing Address - Fax:
Practice Address - Street 1:4324 N BELT LINE RD STE C105
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3538
Practice Address - Country:US
Practice Address - Phone:319-594-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory