Provider Demographics
NPI:1255634440
Name:PEDIATRIC LAB SERVICES INC
Entity type:Organization
Organization Name:PEDIATRIC LAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-3662
Mailing Address - Street 1:12200 MIDDLE SET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5420
Mailing Address - Country:US
Mailing Address - Phone:952-943-8200
Mailing Address - Fax:952-943-8206
Practice Address - Street 1:12200 MIDDLE SET RD STE 100
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5420
Practice Address - Country:US
Practice Address - Phone:952-943-8200
Practice Address - Fax:952-943-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory