Provider Demographics
NPI:1780195966
Name:MIDWEST EQUIPMENT SRV SYSTEMS LLC
Entity Type:Organization
Organization Name:MIDWEST EQUIPMENT SRV SYSTEMS LLC
Other - Org Name:DEFINITIVE LABORATORY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUMLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:314-308-7527
Mailing Address - Street 1:11145 WILL ROGERS
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-308-7527
Mailing Address - Fax:314-552-7511
Practice Address - Street 1:2400 LUCY LEE PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901
Practice Address - Country:US
Practice Address - Phone:573-609-2929
Practice Address - Fax:314-552-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty