Provider Demographics
NPI:1366806010
Name:DIAGNOSTIC LAB SERVICES
Entity type:Organization
Organization Name:DIAGNOSTIC LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-690-8810
Mailing Address - Street 1:16300 ADDISON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5362
Mailing Address - Country:US
Mailing Address - Phone:888-296-2686
Mailing Address - Fax:
Practice Address - Street 1:16300 ADDISON RD STE 110
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5362
Practice Address - Country:US
Practice Address - Phone:888-296-2686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory