Provider Demographics
NPI:1942247705
Name:LEONARD P GIETZ
Entity Type:Organization
Organization Name:LEONARD P GIETZ
Other - Org Name:REGIONAL MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-4821
Mailing Address - Street 1:PO BOX 3784
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3784
Mailing Address - Country:US
Mailing Address - Phone:361-575-4821
Mailing Address - Fax:361-575-0871
Practice Address - Street 1:2710 HOSPITAL DR STE 106
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5743
Practice Address - Country:US
Practice Address - Phone:361-575-0636
Practice Address - Fax:361-575-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5085291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CG66OtherBLUE CROSS
TX097751401Medicaid
TXCL0510OtherBLUE CROSS BLUE SHIELD
TX130599705Medicaid
TX458283OtherMEDICAL LABORATORY
TX130599701Medicaid
TX690003955OtherRAILROAD MEDICARE
TX458283OtherMEDICAL LABORATORY