Organization
SUMMIT CLINICAL LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OSCAR DEREVA (DIRECTOR)
(214) 687-2392
Entity
Organization
Contact information
Practice address
17742 PRESTON RD # 205, DALLAS, TX 75252-6199
(214) 687-2392
(214) 602-7003
Mailing address
2845 CASCADE COVE DR, LITTLE ELM, TX 75068-7607
(214) 687-2392
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
09/15/2020
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