Provider Demographics
NPI:1407806144
Name:SOLSTAS LAB PARTNERS GROUP LLC
Entity Type:Organization
Organization Name:SOLSTAS LAB PARTNERS GROUP LLC
Other - Org Name:SOUTHERN DIAGNOSTIC LABORATORIES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-520-2911
Mailing Address - Street 1:1201 S COLLEGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2998
Mailing Address - Country:US
Mailing Address - Phone:610-454-6146
Mailing Address - Fax:484-676-5188
Practice Address - Street 1:2732 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3406
Practice Address - Country:US
Practice Address - Phone:205-313-1240
Practice Address - Fax:205-313-1250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12279291U00000X
AL01D1015388291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554061Medicaid
AL51517309OtherBCBS OF AL PROVIDER NUMBE
AL051554061Medicaid