Provider Demographics
NPI:1922704121
Name:CLS LABS LLC
Entity Type:Organization
Organization Name:CLS LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RATCHANIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONNUEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-565-2611
Mailing Address - Street 1:1350 W WALNUT HILL LN STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3025
Mailing Address - Country:US
Mailing Address - Phone:469-565-2611
Mailing Address - Fax:469-895-6788
Practice Address - Street 1:1350 W WALNUT HILL LN STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3025
Practice Address - Country:US
Practice Address - Phone:469-565-2611
Practice Address - Fax:469-895-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory