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General NPI Number Information
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NPI Number | 1952777831
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Entity Type | Organization
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Legal Business Name | QUASAR ANALYTICAL LABORATORIES, LLC
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 4835 CENTENNIAL BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3308
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Country | US
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Telephone | 719-309-6270
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Fax | 719-574-2404
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Provider Business Mailing Address
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Address Line | 4419 CENTENNIAL BLVD PMB STE 250
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3739
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Country | US
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Telephone | 719-309-6270
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Fax | 719-574-2404
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS SCOTT KEPHART
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Credential | PH.D.
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Telephone | 719-418-5210
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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 | 06D2108666
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License Number State | CO
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