Provider Demographics
NPI:1710769039
Name:LUXURIOUS LAB TESTING LLC
Entity type:Organization
Organization Name:LUXURIOUS LAB TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEONDRALIQUE
Authorized Official - Middle Name:LASHAE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:NRCMA
Authorized Official - Phone:817-401-7344
Mailing Address - Street 1:3828 CIBOLO DR APT 104
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5576
Mailing Address - Country:US
Mailing Address - Phone:817-401-7344
Mailing Address - Fax:
Practice Address - Street 1:5108 W GORE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6025
Practice Address - Country:US
Practice Address - Phone:866-278-5565
Practice Address - Fax:682-704-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local