1659354645 NPI number — STROMSDORFER-TOLOD MEDICAL LAB LTD.

Table of content: (NPI 1942689559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659354645 NPI number — STROMSDORFER-TOLOD MEDICAL LAB LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STROMSDORFER-TOLOD MEDICAL LAB LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659354645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62002-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-821-8055
Provider Business Mailing Address Fax Number:
314-821-1833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SAINT ANTHONYS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62002-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-465-4511
Provider Business Practice Location Address Fax Number:
618-474-6018
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STROMSDORFER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
618-465-4511

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036039355 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166253 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4503813 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 50000460 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CI7774 . This is a "TRAVELERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43489 . This is a "GHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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