Provider Demographics
NPI:1558621813
Name:BIOMORPH LABS INC.
Entity Type:Organization
Organization Name:BIOMORPH LABS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:309-678-4243
Mailing Address - Street 1:405 N HERSHEY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7925
Mailing Address - Country:US
Mailing Address - Phone:309-662-3002
Mailing Address - Fax:
Practice Address - Street 1:202 ELDERADO DRIVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-662-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D1095444291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory