Provider Demographics
NPI:1871071506
Name:ASSURANCE LABS
Entity type:Organization
Organization Name:ASSURANCE LABS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:469-757-0114
Mailing Address - Street 1:6009 W PARKER RD # 208
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8120
Mailing Address - Country:US
Mailing Address - Phone:469-757-0114
Mailing Address - Fax:
Practice Address - Street 1:6009 W PARKER RD # 208
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8120
Practice Address - Country:US
Practice Address - Phone:972-439-0126
Practice Address - Fax:214-446-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82-2823731OtherEINS