Provider Demographics
NPI:1235024985
Name:ETA LABS
Entity type:Organization
Organization Name:ETA LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CHIEF LEGAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-932-6279
Mailing Address - Street 1:396 W GREENS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4530
Mailing Address - Country:US
Mailing Address - Phone:832-932-6279
Mailing Address - Fax:
Practice Address - Street 1:396 W GREENS RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-4530
Practice Address - Country:US
Practice Address - Phone:832-932-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory