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General NPI Number Information
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NPI Number | 1275891590
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Entity Type | Organization
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Legal Business Name | MID-AMERICA TRANSPLANT SERVICES
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 1110 HIGHLANDS PLAZA DR E 100
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1350
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Country | US
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Telephone | 314-735-8374
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Fax | 314-735-8375
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Provider Business Mailing Address
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Address Line | 1110 HIGHLANDS PLAZA DR E 100
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1350
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Country | US
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Telephone | 314-735-8374
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Fax | 314-735-8375
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Authorized Official
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Title or Position | CEO
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Name | SUSAN DIANE BROCKMEIER
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Credential |
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Telephone | 314-735-8267
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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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