Organization
THYROID SPECIALTY LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA JANSON (FINANCE MANAGER)
(314) 200-3040
Entity
Organization
Contact information
Practice address
1636 HEADLAND DR, FENTON, MO 63026-2837
(314) 200-3040
(314) 200-3042
Mailing address
1636 HEADLAND DR, FENTON, MO 63026-2837
(314) 200-3040
(314) 200-3042
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
26D0953866
MO
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1989
BLUE CROSS BLUE SHIELD
—
01
—
26D0953866
CLIA
—
05
—
703274407
—
MO
Enumeration date
03/30/2007
Last updated
11/22/2024
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