Provider Demographics
NPI:1942278635
Name:LABORATORY MEDICINE SERVICES PA
Entity Type:Organization
Organization Name:LABORATORY MEDICINE SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIEGFRIED
Authorized Official - Middle Name:
Authorized Official - Last Name:PUEBLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-523-2068
Mailing Address - Street 1:PO BOX 740968
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374
Mailing Address - Country:US
Mailing Address - Phone:956-523-2068
Mailing Address - Fax:956-523-2822
Practice Address - Street 1:10700 MCPHERSON RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045
Practice Address - Country:US
Practice Address - Phone:956-523-2068
Practice Address - Fax:956-523-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00993TMedicare ID - Type Unspecified