Provider Demographics
NPI:1194991414
Name:LOU'S CLINICAL LAB
Entity type:Organization
Organization Name:LOU'S CLINICAL LAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LINNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-332-9421
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-0394
Mailing Address - Country:US
Mailing Address - Phone:432-332-9421
Mailing Address - Fax:432-333-9986
Practice Address - Street 1:706 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4639
Practice Address - Country:US
Practice Address - Phone:432-332-9421
Practice Address - Fax:432-333-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K42JMedicare UPIN