Provider Demographics
NPI:1952041584
Name:DR MICRO LABS, LLC
Entity Type:Organization
Organization Name:DR MICRO LABS, LLC
Other - Org Name:DR. MICRO LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANZIL
Authorized Official - Middle Name:TILDEN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-789-2507
Mailing Address - Street 1:1909 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6702
Mailing Address - Country:US
Mailing Address - Phone:817-550-6030
Mailing Address - Fax:817-550-6021
Practice Address - Street 1:2400 AUGUSTA DR STE 194
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4922
Practice Address - Country:US
Practice Address - Phone:281-789-2507
Practice Address - Fax:310-564-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952041584Medicaid