Crestar Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D2098649 Issued in TX

Legal business name

CRESTAR LABS LLC

Practice address

1651 N Collins Blvd Ste 130
Richardson, TX 75080-3658

Phone

(469) 530-9050

Fax

(469) 530-9051

NPI assigned

Aug 25, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Fadel Alshalabi

Title

Ceo

Phone

(704) 433-8888

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1972970978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1651 N COLLINS BLVD STE 130",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803658",
            "telephone_number": "469-530-9050",
            "fax_number": "469-530-9051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 N COLLINS BLVD STE 130",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803658",
            "telephone_number": "469-530-9050",
            "fax_number": "469-530-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTAR LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "ALSHALABI",
        "authorized_official_first_name": "FADEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-433-8888",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D2098649",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3672776-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Richardson, TX
• Providers in Richardson, 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 Jun 11, 2019; 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.