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General NPI Number Information
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NPI Number | 1144397357
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Entity Type | Organization
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Legal Business Name | HEALTHEAST MEDICAL LABORATORY, LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 45 W 10TH STREET
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City | SAINT PAUL
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State | MN
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Zip | 55102-1004
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Country | US
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Telephone | 651-232-3500
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Fax | 651-232-3370
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVENUE
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City | SAINT PAUL
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State | MN
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Zip | 55104
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Country | US
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Telephone | 612-672-2258
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Fax | 612-672-6041
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Authorized Official
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Title or Position | AO DIRECTOR OF NETWORK RELATIONS
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Name | MAUREEN RING
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Credential |
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Telephone | 612-672-6740
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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 | 24D0398925
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License Number State | MN
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