Provider Demographics
NPI:1245277516
Name:BIOCOM CLINICAL LABORATORIES
Entity type:Organization
Organization Name:BIOCOM CLINICAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-969-3612
Mailing Address - Street 1:909 JAMES ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4209
Mailing Address - Country:US
Mailing Address - Phone:956-969-3612
Mailing Address - Fax:956-447-2051
Practice Address - Street 1:909 JAMES ST
Practice Address - Street 2:SUITE E
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4209
Practice Address - Country:US
Practice Address - Phone:956-969-3612
Practice Address - Fax:956-447-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL5066OtherBCBSTX PROVIDER
TX=========OtherHUMANA
TXCL5066OtherBCBSTX PROVIDER
TXCL8453Medicare ID - Type UnspecifiedMEDICARE PROVIDER