Provider Demographics
NPI:1689850497
Name:REGIONAL MEDICAL LABORATORY
Entity type:Organization
Organization Name:REGIONAL MEDICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-4821
Mailing Address - Street 1:2110 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4829
Mailing Address - Country:US
Mailing Address - Phone:361-575-4821
Mailing Address - Fax:361-575-0871
Practice Address - Street 1:2110 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4829
Practice Address - Country:US
Practice Address - Phone:361-575-4821
Practice Address - Fax:361-575-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5085207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL0510Medicare PIN