Provider Demographics
NPI:1437109725
Name:BIOLOGICAL TECHNOLOGY LABORATORY INC
Entity Type:Organization
Organization Name:BIOLOGICAL TECHNOLOGY LABORATORY INC
Other - Org Name:BIOTECH LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-432-5030
Mailing Address - Street 1:10114 WOODFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2923
Mailing Address - Country:US
Mailing Address - Phone:314-432-5030
Mailing Address - Fax:314-373-8060
Practice Address - Street 1:10114 WOODFIELD LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2923
Practice Address - Country:US
Practice Address - Phone:314-432-5030
Practice Address - Fax:314-373-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0050000008OtherBLUE CROSS BLUE SHIELD IL
MO31254OtherBLUE CROSS BLUE SHIELD MO
MO31254OtherBLUE CROSS BLUE SHIELD MO
IL=========01Medicaid
IL0050000008OtherBLUE CROSS BLUE SHIELD IL
MO10302Medicare ID - Type UnspecifiedMEDICARE MO