Provider Demographics
NPI:1922062553
Name:RICHARDS LABORATORIES OF TEXAS
Entity Type:Organization
Organization Name:RICHARDS LABORATORIES OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-785-2500
Mailing Address - Street 1:55 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2233
Mailing Address - Country:US
Mailing Address - Phone:801-785-2500
Mailing Address - Fax:801-785-2521
Practice Address - Street 1:4551 S WESTERN ST
Practice Address - Street 2:#11
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6000
Practice Address - Country:US
Practice Address - Phone:806-352-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0687935291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0687935OtherCLIA NUMBER
TX131063302Medicaid
TX131063302Medicaid
TX45D0687935OtherCLIA NUMBER