Provider Demographics
NPI:1831842897
Name:ARK LA TEX COVID TESTING SOLUTIONS LLC
Entity type:Organization
Organization Name:ARK LA TEX COVID TESTING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-834-5036
Mailing Address - Street 1:916 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3471
Mailing Address - Country:US
Mailing Address - Phone:318-834-5036
Mailing Address - Fax:
Practice Address - Street 1:916 MANOR DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3471
Practice Address - Country:US
Practice Address - Phone:318-834-5036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2248604OtherCLIA WAIVER