MEDICARE: BIOLOGICAL TECHNOLOGY LABORATORY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0050000008	OTHER	IL	BLUE CROSS BLUE SHIELD IL
2	31254	OTHER	MO	BLUE CROSS BLUE SHIELD MO

General Provider Information

NPI Number	:	1437109725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOLOGICAL TECHNOLOGY LABORATORY INC

Provider Business Mailing Address
First Line	:	10114 WOODFIELD LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2923
Country	:	US
Telephone Number	:	314-432-5030
Fax Number	:	314-373-8060

Provider Business Practice Location Address
First Line	:	10114 WOODFIELD LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2923
Country	:	US
Telephone Number	:	314-432-5030
Fax Number	:	314-373-8060

Authorized Official
Title or Position	:	TREASURER
Name	:	WILLIAM JOSEPH HUNT
Credential	:
Telephone Number	:	314-432-5030

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/20/2008

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