Provider Demographics
NPI:1134888191
Name:SUNRISE LABS TX
Entity type:Organization
Organization Name:SUNRISE LABS TX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKBANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-416-0884
Mailing Address - Street 1:3397 N 1200 E STE 108
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3262
Mailing Address - Country:US
Mailing Address - Phone:801-416-0884
Mailing Address - Fax:
Practice Address - Street 1:2825 MILLER RANCH RD STE 221
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9714
Practice Address - Country:US
Practice Address - Phone:801-416-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory