Provider Demographics
NPI:1154549301
Name:MEDICAL SERVISE LAB
Entity type:Organization
Organization Name:MEDICAL SERVISE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-276-3253
Mailing Address - Street 1:PO BOX 19641
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77224-9641
Mailing Address - Country:US
Mailing Address - Phone:832-276-3253
Mailing Address - Fax:
Practice Address - Street 1:5023 PECAN CREEEK
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-9641
Practice Address - Country:US
Practice Address - Phone:832-276-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory