Provider Demographics
NPI:1952844201
Name:CMMS LAB, LLC
Entity Type:Organization
Organization Name:CMMS LAB, LLC
Other - Org Name:CMMS LAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-392-4411
Mailing Address - Street 1:4360 BELTWAY PL
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5262
Mailing Address - Country:US
Mailing Address - Phone:877-304-2667
Mailing Address - Fax:
Practice Address - Street 1:4360 BELTWAY PL
Practice Address - Street 2:SUITE 280
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5262
Practice Address - Country:US
Practice Address - Phone:877-304-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2119882291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2119882OtherCLIA