MEDICARE: SPINNAKERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013282193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINNAKERS LLC

Provider Business Mailing Address
First Line	:	18118 CHESTERFIELD AIRPORT ROAD,
Second Line	:	SUITE#N
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1124
Country	:	US
Telephone Number	:	314-757-7244
Fax Number	:	757-215-0779

Provider Business Practice Location Address
First Line	:	18118 CHESTERFIELD AIRPORT RD
Second Line	:	SUITE#N
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1124
Country	:	US
Telephone Number	:	314-757-7244
Fax Number	:	757-215-0779

Authorized Official
Title or Position	:	CEO
Name	:	MR. ZIA IQBAL
Credential	:
Telephone Number	:	314-757-7244

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	10/25/2012

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