Organization
MISSISSIPPI VALLEY LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE M FARRIS MT ASCP (LABORATORY MANAGER)
(563) 344-6692
Entity
Organization
Contact information
Practice address
3400 DEXTER CT, SUITE 205, DAVENPORT, IA 52807-3461
(563) 344-6690
(563) 344-6699
Mailing address
3400 DEXTER CT, SUITE 205, DAVENPORT, IA 52807-3461
(563) 344-6690
(563) 344-6699
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0142265
—
IA
01
—
54573
BLUE CROSS BLUE SHIELD
IA
Enumeration date
04/27/2006
Last updated
08/22/2020
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