Provider Demographics
NPI:1194239988
Name:ADDISON SYNDICATED LABS
Entity type:Organization
Organization Name:ADDISON SYNDICATED LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CICHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-562-6364
Mailing Address - Street 1:4643 WESTGROVE DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3216
Mailing Address - Country:US
Mailing Address - Phone:214-562-6364
Mailing Address - Fax:
Practice Address - Street 1:4643 WESTGROVE DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3216
Practice Address - Country:US
Practice Address - Phone:214-562-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic