Provider Demographics
NPI:1700204047
Name:MIDWEST REFERENCE LABS LLC
Entity Type:Organization
Organization Name:MIDWEST REFERENCE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-619-9771
Mailing Address - Street 1:363 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 CAMPBELL STATION PKWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7417
Practice Address - Country:US
Practice Address - Phone:248-619-9771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory