Provider Demographics
NPI:1356345946
Name:METROPOLITAN MEDICAL LABORATORY, PLC
Entity type:Organization
Organization Name:METROPOLITAN MEDICAL LABORATORY, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:BILLMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-8555
Mailing Address - Street 1:1814 E LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2038
Mailing Address - Country:US
Mailing Address - Phone:563-324-0471
Mailing Address - Fax:563-326-0115
Practice Address - Street 1:1520 7TH STREET
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2917
Practice Address - Country:US
Practice Address - Phone:309-762-8555
Practice Address - Fax:563-326-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC14D0430746291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
690002426OtherRAILROAD PROVIDER #
IA0002394Medicaid
690002426OtherRAILROAD PROVIDER #
IL148317Medicare ID - Type Unspecified