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General NPI Number Information
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NPI Number | 1831222595
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Entity Type | Organization
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Legal Business Name | ACCURA MEDICAL LABORATORY INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 206 S MAIN ST
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City | O FALLON
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State | MO
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Zip | 63366-2805
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Country | US
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Telephone | 636-978-2228
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Fax | 636-240-0144
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Provider Business Mailing Address
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Address Line | 206 S MAIN ST
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City | O FALLON
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State | MO
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Zip | 63366-2805
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Country | US
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Telephone | 636-978-2228
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Fax | 636-240-0144
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PRAKOB KARL PONGSPIKUL
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Credential | MT(ASCP), SC, MBA
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Telephone | 636-978-2228
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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 | 26D0691515
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License Number State | MO
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