Provider Demographics
NPI:1780676304
Name:BEUTNER LABS INC
Entity Type:Organization
Organization Name:BEUTNER LABS INC
Other - Org Name:BEUTNER LABRATORIES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SURESH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, (D)ABMLI, ABOMP
Authorized Official - Phone:716-838-0549
Mailing Address - Street 1:55 AMHERST VILLA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1400
Mailing Address - Country:US
Mailing Address - Phone:800-960-1080
Mailing Address - Fax:716-838-0798
Practice Address - Street 1:55 AMHERST VILLA RD STE 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-1400
Practice Address - Country:US
Practice Address - Phone:716-838-0549
Practice Address - Fax:716-838-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207KI0005X
NY33D0670252291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1454348OtherUNITED MINE WORKERS
KS200003670AMedicaid
L13381BEOtherEMPIRE/BC/BS
000511524002OtherBLUE CROSS
NY01455283Medicaid
Y044440OtherCHAMPUS
00011194801OtherUNIVERE
1190336OtherIHA
33DD70252OtherCLIA
NY4365OtherPFI
690009305OtherRMC
30002218OtherKEYSTONE MHP
FL911446700Medicaid
=========OtherNORTH AMERICAN
=========OtherCALIF. BL CROSS
33DD70252OtherCLIA
NY01455283Medicaid