Basic Information
| Provider Information | |||||||||
| NPI: | 1427204189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 2920 LAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6225 FM 2920 RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773793474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812570404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6225 FM 2920 RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773793474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812570404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | NAVA | ||||||||
| AuthorizedOfficialFirstName: | SIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8325852447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 45D0932241 | 01 | CLIA | OTHER |