Provider Demographics
NPI:1215091731
Name:DRL LABS LTD
Entity type:Organization
Organization Name:DRL LABS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-531-8845
Mailing Address - Street 1:PO BOX 6640
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711
Mailing Address - Country:US
Mailing Address - Phone:903-531-8991
Mailing Address - Fax:903-594-2438
Practice Address - Street 1:3910 BROOKSIDE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-531-8991
Practice Address - Fax:903-594-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187275OtherMEDICAID
TX10027956OtherMEDICAID AMERIGROUP
LA1187275OtherMEDICAID