Provider Demographics
NPI:1376378083
Name:OMEGA DIAGNOSTIC LABORATORIES
Entity type:Organization
Organization Name:OMEGA DIAGNOSTIC LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-863-6020
Mailing Address - Street 1:4701 FM 2920 RD
Mailing Address - Street 2:STE C1
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3197
Mailing Address - Country:US
Mailing Address - Phone:470-863-6020
Mailing Address - Fax:888-453-1716
Practice Address - Street 1:4701 FM 2920 RD
Practice Address - Street 2:STE C1
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3197
Practice Address - Country:US
Practice Address - Phone:470-863-6020
Practice Address - Fax:888-453-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory