Mediclab Clinical Laboratory,LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MEDICLAB CLINICAL LABORATORY,LLC

Practice address

13900 Beechnut St Ste D
Houston, TX 77083-6599

Phone

(281) 495-4700

Fax

(281) 495-4703

NPI assigned

Jan 21, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Raul Fashe

Title

President

Phone

(281) 495-4700

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322265600000",
    "number": "1578894101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13900 BEECHNUT ST STE D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770836599",
            "telephone_number": "281-495-4700",
            "fax_number": "281-495-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13900 BEECHNUT ST STE D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770836599",
            "telephone_number": "281-495-4700",
            "fax_number": "281-495-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICLAB CLINICAL LABORATORY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-21",
        "last_updated": "2011-11-26",
        "status": "A",
        "authorized_official_last_name": "FASHE",
        "authorized_official_first_name": "RAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "281-495-4700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2801995",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.