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NPI Code Detail

MEDICARE: HEALTH VENTURES OF SOUTHERN ILLINOIS LLC

MEDICARE: HEALTH VENTURES OF SOUTHERN ILLINOIS LLC
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1659351336
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTH VENTURES OF SOUTHERN ILLINOIS LLC
Provider Business Mailing Address
First Line : PO BOX 790051
Second Line :
City : ST LOUIS
State : MO
Zip : 63179-0051
Country : US
Telephone Number : 618-343-0690
Fax Number : 618-343-0689
Provider Business Practice Location Address
First Line : 211 S THIRD STREET
Second Line : TRI LAB LLC
City : BELLEVILLE
State : IL
Zip : 62220-1915
Country : US
Telephone Number : 618-234-2120
Fax Number : 618-222-4612
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. EDWARD HUGHES
Credential :
Telephone Number : 618-343-0639
Provider Enumeration Date : 01/19/2006
Last Update Date : 08/22/2020

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Directions to “HEALTH VENTURES OF SOUTHERN ILLINOIS LLC ” Practice Location

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