Provider Demographics
NPI:1851420822
Name:SOUTHWEST LABS INC
Entity Type:Organization
Organization Name:SOUTHWEST LABS INC
Other - Org Name:SOUTHWEST LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-971-8822
Mailing Address - Street 1:1201 S JACKSON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6860
Mailing Address - Country:US
Mailing Address - Phone:956-971-8822
Mailing Address - Fax:956-688-8230
Practice Address - Street 1:1201 S JACKSON RD
Practice Address - Street 2:STE 2
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6859
Practice Address - Country:US
Practice Address - Phone:956-971-8822
Practice Address - Fax:956-688-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159017604Medicaid
TX159017604Medicaid