Basic Information
| Provider Information | |||||||||
| NPI: | 1467967745 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIANCE DX LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770432737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135596929 | ||||||||
| FaxNumber: | 8883712259 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770432737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135596929 | ||||||||
| FaxNumber: | 8883712259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2017 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | GAUTEREAUX | ||||||||
| AuthorizedOfficialFirstName: | JOHN GREGG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2152059258 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.