Organization
METROSTAT CLINICAL LABORATORY-AUSTIN LLC
Active
Other names
TridentUSA Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA FLETCHER (PROVIDER RELATIONS COORDINATOR)
(303) 307-2081
Entity
Organization
Contact information
Practice address
147 ELMHURST, SUITE 300, KYLE, TX 78640-6117
(512) 922-1151
Mailing address
12075 E 45TH AVE, SUITE 600, DENVER, CO 80239-3123
(303) 371-0073
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2096947
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
356796701
—
TX
01
—
45D2096947
CLIA
TX
Enumeration date
08/20/2015
Last updated
03/09/2020
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