Organization
PETERSON LABORATORY SERVICES, PA
Active
Other names
Peterson Clinical Laboratory, PA
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY J. WERNER (ADMINISTRATOR)
(785) 539-5363
Entity
Organization
Contact information
Practice address
1133 COLLEGE AVE, MANHATTAN, KS 66502-2770
(785) 539-5363
(785) 539-5862
Mailing address
1133 COLLEGE AVE, MANHATTAN, KS 66502-2770
(785) 539-5363
(785) 539-5862
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
17D0449919
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095750B
—
KS
01
—
690077064
RR MEDICARE
KS
Enumeration date
07/19/2006
Last updated
03/06/2012
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