Provider Demographics
NPI:1205294030
Name:GOLDSTAR LABORATORIES MISSOURI LLC
Entity type:Organization
Organization Name:GOLDSTAR LABORATORIES MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLAIMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-755-1818
Mailing Address - Street 1:11669 LILBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3535
Mailing Address - Country:US
Mailing Address - Phone:314-755-1818
Mailing Address - Fax:314-755-1186
Practice Address - Street 1:11669 LILBURN PARK DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63146-3535
Practice Address - Country:US
Practice Address - Phone:314-755-1818
Practice Address - Fax:314-755-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory