Provider Demographics
NPI:1902493513
Name:EVOLUTION LABORATORY SERVICES
Entity Type:Organization
Organization Name:EVOLUTION LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-434-8523
Mailing Address - Street 1:7010 CHAMPIONS PLAZA DR STE 150C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2396
Mailing Address - Country:US
Mailing Address - Phone:713-628-8587
Mailing Address - Fax:281-786-2089
Practice Address - Street 1:7010 CHAMPIONS PLAZA DR STE 150C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-2396
Practice Address - Country:US
Practice Address - Phone:713-628-8587
Practice Address - Fax:281-786-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory