Provider Demographics
NPI:1184090342
Name:FULL SPECTRUM LABORATORIES LLC
Entity type:Organization
Organization Name:FULL SPECTRUM LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:PROF
Authorized Official - First Name:PRAKASAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-487-2248
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:903-487-2248
Mailing Address - Fax:903-487-2306
Practice Address - Street 1:2624 N LOY LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2515
Practice Address - Country:US
Practice Address - Phone:903-487-2248
Practice Address - Fax:903-487-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory