Provider Demographics
NPI:1285708255
Name:LABADVANTAGE SAN ANTONIO LTD
Entity type:Organization
Organization Name:LABADVANTAGE SAN ANTONIO LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-5700
Mailing Address - Street 1:755 S 11TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3732
Mailing Address - Country:US
Mailing Address - Phone:409-833-5700
Mailing Address - Fax:
Practice Address - Street 1:85 NE LOOP 410
Practice Address - Street 2:SUITE 221
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5829
Practice Address - Country:US
Practice Address - Phone:210-342-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory