Organization
APG MEDICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN S VICK DO (OWNER)
(618) 628-8211
Entity
Organization
Contact information
Practice address
916 TALON DR, SUITE 102, O FALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Mailing address
916 TALON DR, SUITE 102, O FALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D0960987
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D0960987
CLIA NUMBER FOR LAB
IL
Enumeration date
03/30/2015
Last updated
09/17/2015
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