Organization
THYROID SPECIALTY LABORATORY INC
Active
Parent organization
THYROID SPECIALTY LABORATORY INC
Other names
Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
THYROID SPECIALTY LABORATORY INC
Authorized official
DR. BHARTUR N PREMACHANDRA DSC PHD FRIC (PRESIDENT DIRECTOR)
(314) 845-7345
Entity
Organization
Contact information
Practice address
2900 LEMAY FERRY RD, SUITE 114, SAINT LOUIS, MO 63125-3900
(314) 845-7345
(314) 845-7345
Mailing address
2900 LEMAY FERRY RD, SUITE 114, SAINT LOUIS, MO 63125-3900
(314) 845-7345
(314) 845-7345
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26D0953866
CLIA
—
05
—
703274407
—
MO
Enumeration date
12/13/2013
Last updated
12/13/2013
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