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General NPI Number Information
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NPI Number | 1730645011
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Entity Type | Organization
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Legal Business Name | MERCY LABS SOUTH LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 10010 KENNERLY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-525-4034
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Fax |
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Provider Business Mailing Address
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Address Line | 645 MARYVILLE CENTRE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5855
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Country | US
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Telephone | 314-628-3690
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Fax |
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Authorized Official
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Title or Position | VP-REGIONAL LABORATORY SRVCS
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Name | MR. MATTHEW POSINSKI
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Credential |
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Telephone | 314-628-6390
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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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