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General NPI Number Information
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NPI Number | 1841999430
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Entity Type | Organization
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Legal Business Name | MOLECULAR LAB ASSOCIATES ILLINOIS
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 2908 GREENBRIAR DR STE A
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7433
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Country | US
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Telephone | 833-480-2441
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Fax |
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Provider Business Mailing Address
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Address Line | 16124 FOSTER ST
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City | OVERLAND PARK
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State | KS
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Zip | 66085-8417
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Country | US
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Telephone | 913-379-9230
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH RENZI
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Credential |
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Telephone | 913-645-8862
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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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