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NPI 1902665839ActiveOrganization· Physiological Laboratory· Dallas, TX
Physiological Laboratory in Dallas, Texas, registered in NPPES in March 2024. The authorized official on file is Conor M. Butts, President. Enrolled in Medicare as part b supplier - independent diagnostic testing facility (idtf) and part b supplier - independent diagnostic testing facility (idtf).
Overview
| NPI | 1902665839 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 14, 2024 |
| Last updated in NPPES | Feb 17, 2026 |
| Certified by provider | Feb 17, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physiological Laboratory Primary | 293D00000X | — | — |
| Clinic/Center, Multi-Specialty | 261QM1300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Independent Diagnostic Testing Facility (Idtf) (MA); Part B Supplier - Independent Diagnostic Testing Facility (Idtf) (TX) |
|---|
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