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General NPI Number Information
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NPI Number | 1255634440
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Entity Type | Organization
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Legal Business Name | PEDIATRIC LAB SERVICES INC
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 12200 MIDDLE SET RD STE 100
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5420
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Country | US
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Telephone | 952-943-8200
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Fax | 952-943-8206
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Provider Business Mailing Address
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Address Line | 12200 MIDDLE SET RD STE 100
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5420
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Country | US
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Telephone | 952-943-8200
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Fax | 952-943-8206
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN BEATTIE
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Credential |
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Telephone | 612-672-3662
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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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