Provider Demographics
NPI:1871538991
Name:SIEBEL DIAGNOSTIC LABORATORIES
Entity type:Organization
Organization Name:SIEBEL DIAGNOSTIC LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-276-0902
Mailing Address - Street 1:8204 ELMBROOK DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4067
Mailing Address - Country:US
Mailing Address - Phone:214-276-0902
Mailing Address - Fax:214-276-0906
Practice Address - Street 1:8204 ELMBROOK DR
Practice Address - Street 2:SUITE 117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4067
Practice Address - Country:US
Practice Address - Phone:214-276-0902
Practice Address - Fax:214-276-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8577Medicare ID - Type Unspecified