Provider Demographics
NPI:1760189898
Name:ETX DIAGNOSTICS LLC
Entity type:Organization
Organization Name:ETX DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-830-3009
Mailing Address - Street 1:12849 CAPRICORN ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3911
Mailing Address - Country:US
Mailing Address - Phone:702-830-3009
Mailing Address - Fax:346-857-0230
Practice Address - Street 1:12849 CAPRICORN ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3911
Practice Address - Country:US
Practice Address - Phone:346-335-3953
Practice Address - Fax:346-857-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory