Provider Demographics
NPI:1265619803
Name:LABORATORY COLLECTION SERVICES INC
Entity type:Organization
Organization Name:LABORATORY COLLECTION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DALTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-413-3470
Mailing Address - Street 1:5545 GREENTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3811
Mailing Address - Country:US
Mailing Address - Phone:314-413-3470
Mailing Address - Fax:314-416-8224
Practice Address - Street 1:5545 GREENTON WAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3811
Practice Address - Country:US
Practice Address - Phone:314-413-3470
Practice Address - Fax:314-416-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014628Medicare PIN