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General NPI Number Information
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NPI Number | 1396175196
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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 | 11/15/2013
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 1636 HEADLAND DR
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City | FENTON
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State | MO
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Zip | 63026-2837
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Country | US
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Telephone | 314-200-3040
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Fax | 314-200-3042
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Provider Business Mailing Address
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Address Line | 1636 HEADLAND DR
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City | FENTON
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State | MO
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Zip | 63026-2837
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Country | US
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Telephone | 314-200-2040
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Fax | 314-200-3042
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE & CREDENTIAL
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Name | MARCIA ECKRICH
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Credential |
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Telephone | 314-200-3040
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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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