Organization
NICKL LABS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE WOODS (ADMINISTRATION)
(409) 923-0012
Entity
Organization
Contact information
Practice address
6310 DELAWARE ST STE 122, BEAUMONT, TX 77706-7646
(409) 923-0012
(409) 291-8010
Mailing address
6310 DELAWARE ST STE 122, BEAUMONT, TX 77706-7646
(409) 923-0012
(409) 291-8010
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL5957
BLUE CROSS BLUE SHIELD
TX
Enumeration date
01/22/2018
Last updated
01/22/2018
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