Provider Demographics
NPI:1588923213
Name:NOVATION DIAGNOSTICS LLC
Entity type:Organization
Organization Name:NOVATION DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SRIDHARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAGOPALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-962-8121
Mailing Address - Street 1:8980 KIRBY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2830
Mailing Address - Country:US
Mailing Address - Phone:832-962-8121
Mailing Address - Fax:832-962-8167
Practice Address - Street 1:8980 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2830
Practice Address - Country:US
Practice Address - Phone:832-962-8121
Practice Address - Fax:832-962-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333017701Medicaid