Provider Demographics
NPI:1427454321
Name:LUCENTA LABORATORY CORP
Entity type:Organization
Organization Name:LUCENTA LABORATORY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:MOHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-316-3344
Mailing Address - Street 1:7589 PRESTON RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5667
Mailing Address - Country:US
Mailing Address - Phone:972-316-3344
Mailing Address - Fax:972-316-3322
Practice Address - Street 1:7589 PRESTON RD
Practice Address - Street 2:SUITE 900
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5667
Practice Address - Country:US
Practice Address - Phone:972-316-3344
Practice Address - Fax:972-316-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2018771291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291U00000XOtherTAXONOMY
TX030369501Medicaid
TX720000125OtherMEDICARE RAILROAD INDIVIDUAL
TX0045AAMedicare PIN
TXP00331394OtherMEDICARE RAILROAD INDIVIDUAL
TX8G8317Medicare PIN
TXCJ8159OtherMEDICARE RAILROAD GROUP
TX8954M0Medicare PIN
TX184682601Medicaid
TX00449RMedicare PIN