1891747093 NPI number — PHYSICIANS LABORATORY, LTD.

Table of content: (NPI 1891747093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891747093 NPI number — PHYSICIANS LABORATORY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS LABORATORY, 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:
PHYSICIANS LABORATORY
Provider Other Organization Name Type Code:
5
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:
1891747093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-322-7200
Provider Business Mailing Address Fax Number:
605-322-7222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 S CLIFF AVE
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-7200
Provider Business Practice Location Address Fax Number:
605-322-7222
Provider Enumeration Date:
05/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRANDT
Authorized Official First Name:
LEE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
605-322-7208

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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