Provider Demographics
NPI:1134714991
Name:NOVA DIAGNOSTICS LABS
Entity type:Organization
Organization Name:NOVA DIAGNOSTICS LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-955-4646
Mailing Address - Street 1:11035 RESOURCE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6071
Mailing Address - Country:US
Mailing Address - Phone:630-518-1049
Mailing Address - Fax:
Practice Address - Street 1:11035 RESOURCE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6071
Practice Address - Country:US
Practice Address - Phone:630-518-1049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory