Provider Demographics
NPI:1811323827
Name:SAMARITAN LABORATORIES LLC
Entity type:Organization
Organization Name:SAMARITAN LABORATORIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RESENDIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-395-3321
Mailing Address - Street 1:2501 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:844-281-6510
Mailing Address - Fax:888-316-0469
Practice Address - Street 1:4715 TRADERS WAY
Practice Address - Street 2:STE 201
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179
Practice Address - Country:US
Practice Address - Phone:615-435-3436
Practice Address - Fax:615-614-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
103G696892Medicare PIN