Organization
CEDAR CREEK LABS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TY BRUGGEMAN (OWNER)
(281) 714-9996
Entity
Organization
Contact information
Practice address
4200 BURCH DR STE C9, DEL VALLE, TX 78617-3234
(511) 714-9996
(888) 793-0432
Mailing address
4200 BURCH DR STE C9, DEL VALLE, TX 78617-3234
(511) 714-9996
(888) 793-0432
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2010541
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2010541
CLIA
TX
Enumeration date
11/10/2016
Last updated
11/10/2016
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