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General NPI Number Information
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NPI Number | 1831961036
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Entity Type | Organization
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Legal Business Name | 360 MEDICAL TESTING SOLUTIONS LLC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 2354 SUCASA DR APT A
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City | FLORISSANT
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State | MO
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Zip | 63031-6613
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Country | US
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Telephone | 314-722-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 819 S BELT W
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City | BELLEVILLE
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State | IL
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Zip | 62220-2324
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Country | US
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Telephone | 618-744-7006
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Fax | 618-744-7006
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Authorized Official
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Title or Position | CEO
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Name | ANDRA VAUGHN
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Credential |
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Telephone | 314-722-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QL0900X
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Taxonomy Name | Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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