NPIMap

Organization Active NPI

Thyroid Specialty Laboratory Inc

  • Clinical Medical Laboratory
  • Saint Louis, MO
National Provider Identifier
1184055386
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
THYROID SPECIALTY LABORATORY INC
Practice address
2900 Lemay Ferry Rd
Suite 114
Saint Louis, MO 63125-3900
Phone
(314) 845-7345
Fax
(314) 845-7345
NPI assigned
Dec 13, 2013
Organization subpart
Yes
Parent organization
THYROID SPECIALTY LABORATORY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bhartur N Premachandra, DSC PHD FRIC
Title
President Director
Phone
(314) 845-7345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2900 Lemay Ferry Rd
Suite 114
Saint Louis, MO 63125-3900

Mailing address

2900 Lemay Ferry Rd
Suite 114
Saint Louis, MO 63125-3900
Phone (314) 845-7345

Other identifiers 2

IdentifierTypeStateIssuer
703274407MedicaidMO
26D0953866OtherCLIA

Other names 1

  • Lab Other name

National Provider Directory

National Provider Directory
Tax ID family
Thyroid Specialty Lab Inc3 organizations share this tax ID, including this one
Part of
Thyroid Specialty Lab Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1184055386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 LEMAY FERRY RD",
            "address_2": "SUITE 114",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631253900",
            "telephone_number": "314-845-7345",
            "fax_number": "314-845-7345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 LEMAY FERRY RD",
            "address_2": "SUITE 114",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631253900",
            "telephone_number": "314-845-7345",
            "fax_number": "314-845-7345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THYROID SPECIALTY LABORATORY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THYROID SPECIALTY LABORATORY INC",
        "enumeration_date": "2013-12-13",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "PREMACHANDRA",
        "authorized_official_first_name": "BHARTUR",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "314-845-7345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DSC PHD FRIC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "703274407",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0953866",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.