Organization
SURETEST LABORATORY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH CHARLES LUTKA JR. (OWNER)
(817) 426-9355
Entity
Organization
Contact information
Practice address
4609 COUNTY ROAD 919, CROWLEY, TX 76036-5535
(817) 426-9355
(817) 426-9357
Mailing address
4609 COUNTY ROAD 919, CROWLEY, TX 76036-5535
(817) 426-9355
(817) 426-9357
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D1092429
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183907801
—
TX
01
—
CL1045
MEDICARE TPAN
TX
Enumeration date
06/21/2010
Last updated
08/13/2010
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