Provider Demographics
NPI:1891547790
Name:TCF LAB SERVICE LLC
Entity type:Organization
Organization Name:TCF LAB SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KISSENTANER
Authorized Official - Suffix:
Authorized Official - Credentials:CMAC,CP
Authorized Official - Phone:936-221-1099
Mailing Address - Street 1:1601 E LAMAR BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4465
Mailing Address - Country:US
Mailing Address - Phone:936-221-1099
Mailing Address - Fax:
Practice Address - Street 1:1601 E LAMAR BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4465
Practice Address - Country:US
Practice Address - Phone:936-221-1099
Practice Address - Fax:469-281-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory