Organization
MIDWEST LABORATORY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAWED H SIDDIQUI M.D. (OWNER)
(314) 285-3044
Entity
Organization
Contact information
Practice address
11115 NEW HALLS FERRY RD STE 206, FLORISSANT, MO 63033-7612
(314) 285-3044
(314) 395-8925
Mailing address
11115 NEW HALLS FERRY RD STE 206, FLORISSANT, MO 63033-7612
(314) 285-3044
(314) 395-8925
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
LC001485840
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26D2112849
CLIA
MO
Enumeration date
06/15/2016
Last updated
06/15/2016
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