Provider Demographics
NPI:1316257603
Name:MEDICUS LABORATORIES
Entity type:Organization
Organization Name:MEDICUS LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-386-6399
Mailing Address - Street 1:5710 LBJ FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6324
Mailing Address - Country:US
Mailing Address - Phone:877-227-6048
Mailing Address - Fax:972-386-6603
Practice Address - Street 1:5710 LBJ FWY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6324
Practice Address - Country:US
Practice Address - Phone:972-386-6399
Practice Address - Fax:972-386-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory