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General NPI Number Information
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NPI Number | 1184055386
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Entity Type | Organization
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Legal Business Name | THYROID SPECIALTY LABORATORY INC
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 2900 LEMAY FERRY RD SUITE 114
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3900
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Country | US
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Telephone | 314-845-7345
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Fax | 314-845-7345
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Provider Business Mailing Address
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Address Line | 2900 LEMAY FERRY RD SUITE 114
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3900
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Country | US
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Telephone | 314-845-7345
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Fax | 314-845-7345
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Authorized Official
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Title or Position | PRESIDENT DIRECTOR
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Name | DR. BHARTUR N PREMACHANDRA
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Credential | DSC PHD FRIC
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Telephone | 314-845-7345
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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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