Provider Demographics
NPI:1417627308
Name:MDX DIAGNOSTICS LABORATORY
Entity type:Organization
Organization Name:MDX DIAGNOSTICS LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAISHADH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-372-9971
Mailing Address - Street 1:6201 BONHOMME RD STE 410S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4386
Mailing Address - Country:US
Mailing Address - Phone:832-372-9971
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 410S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4386
Practice Address - Country:US
Practice Address - Phone:832-372-9971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory