Provider Demographics
NPI:1326882283
Name:MAX MEDICAL LABS LLC
Entity type:Organization
Organization Name:MAX MEDICAL LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MOTASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSHOMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-780-2814
Mailing Address - Street 1:1026 W DALLAS ST STE B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-1012
Mailing Address - Country:US
Mailing Address - Phone:469-780-2814
Mailing Address - Fax:
Practice Address - Street 1:1026 W DALLAS ST STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1012
Practice Address - Country:US
Practice Address - Phone:469-780-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory