Provider Demographics
NPI:1326283383
Name:MINERAL AREA LABORATORIES LLC
Entity Type:Organization
Organization Name:MINERAL AREA LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIDIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-275-9737
Mailing Address - Street 1:PO BOX 78159
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-8159
Mailing Address - Country:US
Mailing Address - Phone:800-354-1088
Mailing Address - Fax:314-845-5668
Practice Address - Street 1:1212 WEBER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3325
Practice Address - Country:US
Practice Address - Phone:573-756-4581
Practice Address - Fax:573-756-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty