Organization
STAT DIAGNOSTIC LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DELIA DELORES BOOKER (PRESIDENT)
(214) 434-4032
Entity
Organization
Contact information
Practice address
509 N HAMPTON RD, SUITE 204, DESOTO, TX 75115-4970
(972) 230-2323
(972) 230-2324
Mailing address
4515 COLONIAL AVE, DALLAS, TX 75215-4140
(214) 434-4032
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20449
CLIA
MD
01
—
45D1064567
CLIA
TX
Enumeration date
02/23/2007
Last updated
06/05/2008
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