Organization
MYCODART INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY HOOPER (CFO)
(972) 492-0419
Entity
Organization
Contact information
Practice address
4100 FAIRWAY DR STE 640, CARROLLTON, TX 75010-6525
(972) 492-0419
(972) 243-7759
Mailing address
4100 FAIRWAY DR STE 640, CARROLLTON, TX 75010-6525
(972) 492-0419
(972) 243-7759
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2158080
CLIA
—
Enumeration date
11/07/2019
Last updated
11/07/2019
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