Organization
EASTRIDGE MEDICAL LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT YOUNG (DIRECTOR)
(816) 233-9313
Entity
Organization
Contact information
Practice address
212 SOUTH WOODBINE RD, SAINT JOSEPH, MO 64506
(816) 233-9313
(816) 233-5043
Mailing address
PO BOX 8687, SAINT JOSEPH, MO 64508-8687
(816) 233-9313
(816) 233-5043
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26DO652292
CLIA
—
05
—
7059727201
—
KS
Enumeration date
09/22/2005
Last updated
03/05/2009
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