1356345946 NPI number — METROPOLITAN MEDICAL LABORATORY, PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356345946 NPI number — METROPOLITAN MEDICAL LABORATORY, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN MEDICAL LABORATORY, PLC
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:
6
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:
1356345946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1814 E LOCUST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52803-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-324-0471
Provider Business Mailing Address Fax Number:
563-326-0115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-762-8555
Provider Business Practice Location Address Fax Number:
563-326-0115
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BILLMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
309-762-8555

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  14D0430746 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 690002426 . This is a "RAILROAD PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002394 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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