Organization
INNOVATIVE PATHOLOGY LABORATORY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY BUTLER (ADMINISTRATOR)
(713) 416-7749
Entity
Organization
Contact information
Practice address
1475 FM 1960 BYPASS RD E, HUMBLE, TX 77338-3909
(713) 416-7749
Mailing address
1475 FM 1960 BYPASS RD E, HUMBLE, TX 77338-3909
(713) 416-7749
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D209495
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2099495
CLIA
TX
Enumeration date
11/09/2015
Last updated
11/09/2015
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