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General NPI Number Information
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NPI Number | 1003406232
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Entity Type | Organization
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Legal Business Name | STL DIAGNOSTIC LLC
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 5203 CHIPPEWA ST STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2356
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Country | US
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Telephone | 314-349-2869
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Fax |
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Provider Business Mailing Address
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Address Line | 5203 CHIPPEWA ST STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2356
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Country | US
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Telephone | 314-349-2869
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SYED HAIDER
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Credential |
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Telephone | 636-675-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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