Provider Demographics
NPI:1457003329
Name:BETA DIAGNOSTIC LABS LLC
Entity Type:Organization
Organization Name:BETA DIAGNOSTIC LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOUSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-583-0068
Mailing Address - Street 1:7200 WASHINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-6516
Mailing Address - Country:US
Mailing Address - Phone:262-583-0068
Mailing Address - Fax:262-583-0079
Practice Address - Street 1:7200 WASHINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-6516
Practice Address - Country:US
Practice Address - Phone:262-583-0068
Practice Address - Fax:262-583-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory