Basic Information
| Provider Information | |||||||||
| NPI: | 1184090342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FULL SPECTRUM LABORATORIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 837 | ||||||||
| Address2: | |||||||||
| City: | HOWE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754590837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034872248 | ||||||||
| FaxNumber: | 9034872306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2624 N LOY LAKE RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750902515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034872248 | ||||||||
| FaxNumber: | 9034872306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 08/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | KRISHNARAJ | ||||||||
| AuthorizedOfficialFirstName: | PRAKASAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9034872248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | PROF. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.