Organization
PHYSICIANS REFERENCE LABORATORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY J KEITGES (COO)
(913) 338-4070
Entity
Organization
Contact information
Practice address
3840 W 75TH ST, PRAIRIE VILLAGE, KS 66208-4126
(913) 338-4070
(913) 338-4245
Mailing address
7800 W 110TH ST, STE 200, OVERLAND PARK, KS 66210-2304
(913) 338-4070
(913) 338-4245
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
690008419
RAILROAD MEDICARE
KS
Enumeration date
03/28/2007
Last updated
03/07/2013
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