1083946735 NPI number — SANDRA POLOE DBA A1 LABORATORY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083946735 NPI number — SANDRA POLOE DBA A1 LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDRA POLOE DBA A1 LABORATORY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A1 LABORATORY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083946735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 331515
Provider Second Line Business Mailing Address:
11500 NORTHWEST FREEWAY STE.435
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77233-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-931-4848
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11500 NORTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 435
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77092-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-931-4848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
POLOE
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
713-931-4848

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  45D1107637 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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