Provider Demographics
NPI:1013315233
Name:HOUSTON PARK PRECISE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:HOUSTON PARK PRECISE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARTSEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-668-7889
Mailing Address - Street 1:6201 BONHOMME RD STE 408S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4384
Mailing Address - Country:US
Mailing Address - Phone:847-668-7889
Mailing Address - Fax:224-357-9197
Practice Address - Street 1:6201 BONHOMME RD STE 408S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4384
Practice Address - Country:US
Practice Address - Phone:847-668-7889
Practice Address - Fax:224-357-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory