Provider Demographics
NPI:1891355327
Name:TX DIAGNOSTICS LLC
Entity type:Organization
Organization Name:TX DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-3852
Mailing Address - Street 1:305 NE 2ND AVE
Mailing Address - Street 2:PO BOX 37
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3801
Mailing Address - Country:US
Mailing Address - Phone:214-396-3852
Mailing Address - Fax:214-396-3853
Practice Address - Street 1:1651 N COLLINS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3658
Practice Address - Country:US
Practice Address - Phone:214-396-3852
Practice Address - Fax:214-396-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory