Healthcare Provider Details

I. General information

NPI: 1326761198
Provider Name (Legal Business Name): COMO LAB SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CORONA RD STE 309
COLUMBIA MO
65203-5931
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-3816
  • Fax: 314-226-1736
Mailing address:
  • Phone: 314-543-3816
  • Fax: 314-226-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD J DESTEFANE
Title or Position: CO-MANAGER
Credential:
Phone: 314-543-3816