Provider Demographics
NPI:1922242577
Name:METROSTAT CLINICAL LABORATORY, INC
Entity Type:Organization
Organization Name:METROSTAT CLINICAL LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-205-1144
Mailing Address - Street 1:325 GOLD ST
Mailing Address - Street 2:118
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6658
Mailing Address - Country:US
Mailing Address - Phone:972-205-1144
Mailing Address - Fax:972-205-1115
Practice Address - Street 1:325 GOLD ST
Practice Address - Street 2:118
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6658
Practice Address - Country:US
Practice Address - Phone:972-205-1144
Practice Address - Fax:972-205-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1098295291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory