Provider Demographics
NPI:1770153090
Name:BNB DIAGNOSTICS
Entity type:Organization
Organization Name:BNB DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENNEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-494-3543
Mailing Address - Street 1:350 NURSERY RD STE 3102
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4079
Mailing Address - Country:US
Mailing Address - Phone:346-351-1203
Mailing Address - Fax:
Practice Address - Street 1:350 NURSERY RD STE 3102
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-4079
Practice Address - Country:US
Practice Address - Phone:346-351-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory