Provider Demographics
NPI:1457507204
Name:PHYSICIANS REFERENCE LABORATORY
Entity Type:Organization
Organization Name:PHYSICIANS REFERENCE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEITGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-338-4070
Mailing Address - Street 1:7800 W 110TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2304
Mailing Address - Country:US
Mailing Address - Phone:913-338-4070
Mailing Address - Fax:913-338-4245
Practice Address - Street 1:3208 W 81ST TER
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1108
Practice Address - Country:US
Practice Address - Phone:913-338-4070
Practice Address - Fax:913-338-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZN0500X, 207ZP0007X, 207ZP0101X, 207ZP0102X
KS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Multi-Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDD4483OtherRAILROAD MEDICARE
KSDD4483OtherRAILROAD MEDICARE