Provider Demographics
NPI:1255053153
Name:ASTRO LABZ PERMIAN BASIN
Entity type:Organization
Organization Name:ASTRO LABZ PERMIAN BASIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-676-1281
Mailing Address - Street 1:705 W WADLEY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5300
Mailing Address - Country:US
Mailing Address - Phone:432-202-0321
Mailing Address - Fax:
Practice Address - Street 1:10810 E AUBURN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:TX
Practice Address - Zip Code:79758-4901
Practice Address - Country:US
Practice Address - Phone:432-202-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory