Provider Demographics
NPI:1841515731
Name:PERITUS LABORATORIES, INC
Entity type:Organization
Organization Name:PERITUS LABORATORIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:812-288-5950
Mailing Address - Street 1:6203 GHEENS MILL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-9214
Mailing Address - Country:US
Mailing Address - Phone:812-288-5950
Mailing Address - Fax:812-255-5951
Practice Address - Street 1:6203 GHEENS MILL RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-9214
Practice Address - Country:US
Practice Address - Phone:812-288-5950
Practice Address - Fax:812-255-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
M300022988Medicare PIN