SAM HOUSTON PARK DIAGNOSTICS, LLC - NPI NUMBER 1750713053

Summary

Provider Name: SAM HOUSTON PARK DIAGNOSTICS, LLC

NPI Number: 1750713053

Clasification: Clinical Medical Laboratory (291U00000X)

Address:
6201 BONHOMME RD
434 S
HOUSTON, TX
ZIP 77036

Phone Number: (713) 975-1151



Detailed Information

SAM HOUSTON PARK DIAGNOSTICS, LLC is a clinical medical laboratory in Houston, TX. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. The assigned NPI number for this provider is 1750713053 and is registered as an organization entity type.

The provider's business address is:

6201 BONHOMME RD
434 S
HOUSTON, TX
ZIP 77036-365
Phone: (713) 975-1151
Fax: (312) 256-9749

The provider's authorized official is Steve Molchanov .
The authorized official title is Owner/president and has the following contact phone number (713) 975-1151.

The enumeration date for this NPI number is 8/8/2013 and was last updated on 10/25/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 291U00000X Clinical Medical Laboratory Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1750713053 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name SAM HOUSTON PARK DIAGNOSTICS, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 6201 BONHOMME RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address 434 S The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name HOUSTON The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name TX The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 770364365 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 7139751151 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 3122569749 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 8/8/2013 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 10/25/2013 The date that a record was last updated or changed.
15 Authorized Official Last Name MOLCHANOV The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name STEVE The first name of the authorized official.
17 Authorized Official Title or Position OWNER/PRESIDENT The title or position of the authorized official.
18 Authorized Official Telephone Number 7139751151 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 291U00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Organization Subpart N
22 Authorized Official Name Prefix Text MR.

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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