Midwest Laboratory Services LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

LC001485840 Issued in MO

Legal business name

MIDWEST LABORATORY SERVICES LLC

Practice address

11115 New Halls Ferry Rd Ste 206
Florissant, MO 63033-7612

Phone

(314) 285-3044

Fax

(314) 395-8925

NPI assigned

Jun 15, 2016

Last updated

Jun 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jawed H Siddiqui, M.D.NPI 1699705293

Title

Owner

Phone

(314) 285-3044

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jawed H. Siddiqui, M.D.

  • Internal Medicine Physician
  • Florissant, MO
  • NPI 1699705293
  NPD (past) Authorized official

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1225488794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11115 NEW HALLS FERRY RD STE 206",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630337612",
            "telephone_number": "314-285-3044",
            "fax_number": "314-395-8925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11115 NEW HALLS FERRY RD STE 206",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630337612",
            "telephone_number": "314-285-3044",
            "fax_number": "314-395-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST LABORATORY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "JAWED",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-285-3044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MO",
            "license": "LC001485840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D2112849",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Florissant, MO
• Providers in Florissant, MO by specialty
• Clinical Medical Laboratory in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.