Provider Demographics
NPI:1568489524
Name:PHYSICIANS REFERENCE LABORATORY LLC
Entity Type:Organization
Organization Name:PHYSICIANS REFERENCE LABORATORY LLC
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 1:7800 W 110TH ST
Practice Address - Street 2:STE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2304
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:2006-07-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9004026Medicare PIN