Healthcare Provider Details

I. General information

NPI: 1942282496
Provider Name (Legal Business Name): MOSAIC DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/11/2023
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 QUIVIRA ROAD
OVERLAND PARK KS
66215
US

IV. Provider business mailing address

8400 W 110TH STREET SUITE 500
OVERLAND PARK KS
66210
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-8949
  • Fax: 913-254-3331
Mailing address:
  • Phone: 913-341-8949
  • Fax: 913-254-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number17D0919496
License Number StateKS

VIII. Authorized Official

Name: MICHEL MEYERS
Title or Position: DIRECTOR OF REGULATORY COMPLIANCE A
Credential:
Phone: 913-341-8949