Provider Demographics
NPI:1669451977
Name:HEALTH VENTURES OF SOUTHERN ILLONOIS LLC
Entity Type:Organization
Organization Name:HEALTH VENTURES OF SOUTHERN ILLONOIS LLC
Other - Org Name:TRI-LAB LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-343-0639
Mailing Address - Street 1:PO BOX 790051
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0051
Mailing Address - Country:US
Mailing Address - Phone:618-343-0640
Mailing Address - Fax:618-343-0684
Practice Address - Street 1:180 S 3RD ST
Practice Address - Street 2:STE 300 TRI-LAB LLC @ ST ELIZABETH'S MEDICAL ARTS BUILD
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1952
Practice Address - Country:US
Practice Address - Phone:618-233-4187
Practice Address - Fax:618-239-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
258610Medicare ID - Type Unspecified