Provider Demographics
NPI:1013504091
Name:CEDAR PARK COVID TEST
Entity Type:Organization
Organization Name:CEDAR PARK COVID TEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-608-3118
Mailing Address - Street 1:2233 AMBUSH CYN
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-8893
Mailing Address - Country:US
Mailing Address - Phone:512-608-3118
Mailing Address - Fax:
Practice Address - Street 1:1120 COTTONWOOD CREEK TRL STE 180B
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6652
Practice Address - Country:US
Practice Address - Phone:512-737-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center