Provider Demographics
NPI:1366566010
Name:HKA CORP DBA
Entity type:Organization
Organization Name:HKA CORP DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-447-2266
Mailing Address - Street 1:925 W DAGGETT ST
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-6902
Mailing Address - Country:US
Mailing Address - Phone:432-447-2808
Mailing Address - Fax:
Practice Address - Street 1:925 W DAGGETT ST
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-6902
Practice Address - Country:US
Practice Address - Phone:432-447-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89W050291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89W050Medicare ID - Type UnspecifiedLAB RADIOLOGY MEDICARE #