Organization
STATE OF MISSOURI
Active
Other names
MO State Public Health Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC BLANK PHD (LABORATORY DIRECTOR)
(573) 751-7233
Entity
Organization
Contact information
Practice address
101 CHESTNUT ST, JEFFERSON CITY, MO 65101-4081
(573) 751-3334
(573) 526-2754
Mailing address
PO BOX 570, 101 N. CHESTNUT ST., JEFFERSON CITY, MO 65102-0570
(573) 751-3334
(573) 526-2754
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703405001
—
MO
Enumeration date
07/16/2006
Last updated
06/27/2008
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