Provider Demographics
NPI:1659354645
Name:STROMSDORFER-TOLOD MEDICAL LAB LTD.
Entity Type:Organization
Organization Name:STROMSDORFER-TOLOD MEDICAL LAB LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STROMSDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-465-4511
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-1063
Mailing Address - Country:US
Mailing Address - Phone:314-821-8055
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:1 SAINT ANTHONYS WAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4568
Practice Address - Country:US
Practice Address - Phone:618-465-4511
Practice Address - Fax:618-474-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036039355Medicaid
IL166253OtherHEALTHLINK
IL4503813OtherAETNA
IL50000460OtherBCBS
CI7774OtherTRAVELERS
IL43489OtherGHP
IL4503813OtherAETNA