Organization
LEONARD P GIETZ
Active
Other names
Regional Medical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY HELMERS (BILLING CLERK)
(361) 575-4821
Entity
Organization
Contact information
Practice address
2710 HOSPITAL DR STE 106, VICTORIA, TX 77901-5743
(361) 575-0636
(361) 575-0871
Mailing address
PO BOX 3784, VICTORIA, TX 77903-3784
(361) 575-4821
(361) 575-0871
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
E5085
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00CG66
BLUE CROSS
TX
05
—
097751401
—
TX
05
—
130599701
—
TX
05
—
130599705
—
TX
01
—
458283
MEDICAL LABORATORY
TX
01
—
690003955
RAILROAD MEDICARE
TX
01
—
CL0510
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/01/2006
Last updated
12/29/2011
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