Provider Demographics
NPI:1013282193
Name:SPINNAKERS LLC
Entity Type:Organization
Organization Name:SPINNAKERS LLC
Other - Org Name:NORTH COUNTY DIAGNOSTIC LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-757-7244
Mailing Address - Street 1:18118 CHESTERFIELD AIRPORT ROAD,
Mailing Address - Street 2:SUITE#N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1124
Mailing Address - Country:US
Mailing Address - Phone:314-757-7244
Mailing Address - Fax:757-215-0779
Practice Address - Street 1:18118 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:SUITE#N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1124
Practice Address - Country:US
Practice Address - Phone:314-757-7244
Practice Address - Fax:757-215-0779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINNAKERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO70663290Medicaid
MOMA4052Medicare PIN