# MINERAL AREA LABORATORIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326283383
- **Authorized official:** RUSSELL DEIDIKER MD (PROVIDER)
- **Authorized official phone:** (888) 275-9737

## Contact information

- **Practice address:** 1212 WEBER RD, FARMINGTON, MO 63640-3325
- **Practice address phone:** (573) 756-4581
- **Practice address fax:** (573) 756-7197
- **Mailing address:** PO BOX 78159, SAINT LOUIS, MO 63178-8159
- **Mailing address phone:** (800) 354-1088
- **Mailing address fax:** (314) 845-5668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2008
- **Last updated:** 12/04/2008