Provider Demographics
NPI:1578619029
Name:DIAGNOSTIC LABORATORY SERVICES, PLC
Entity Type:Organization
Organization Name:DIAGNOSTIC LABORATORY SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-739-3911
Mailing Address - Street 1:1500 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1849
Mailing Address - Country:US
Mailing Address - Phone:231-739-3911
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-739-3911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI029613OtherMIDWEST HEALTH PLAN
MI107391OtherCARE CHOICES
MIXX09319OtherHEALTHPLUS
MI0F16031OtherBLUE CROSS BLUE SHIELD
MI970308OtherCOMMUNITY CARE PLAN
MI0F16031OtherMCARE
MICK0248OtherRAILROAD MEDICARE
MI1008785OtherKENT HEALTH PLAN
MI1008785OtherTENCON HEALTH PLAN
MI37137OtherCOMMUNITY CHOICE MI
MI0F16031OtherBLUE CROSS BLUE SHIELD