Provider Demographics
NPI:1861867517
Name:SUGAR LAND DIAGNOSTIC, INC
Entity Type:Organization
Organization Name:SUGAR LAND DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-500-4250
Mailing Address - Street 1:3519 TOWN CENTER BLVD S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1000
Mailing Address - Country:US
Mailing Address - Phone:832-500-4250
Mailing Address - Fax:832-500-4244
Practice Address - Street 1:3519 TOWN CENTER BLVD S
Practice Address - Street 2:SUITE B
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1000
Practice Address - Country:US
Practice Address - Phone:832-500-4250
Practice Address - Fax:832-500-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory