Provider Demographics
NPI:1750713053
Name:SAM HOUSTON PARK DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:SAM HOUSTON PARK DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLCHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-975-1151
Mailing Address - Street 1:6201 BONHOMME RD
Mailing Address - Street 2:434 S
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4365
Mailing Address - Country:US
Mailing Address - Phone:713-975-1151
Mailing Address - Fax:312-256-9749
Practice Address - Street 1:6201 BONHOMME RD
Practice Address - Street 2:434 S
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:713-975-1151
Practice Address - Fax:312-256-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory