Provider Demographics
NPI:1447933478
Name:MJB INDUSTRIES, LLC
Entity type:Organization
Organization Name:MJB INDUSTRIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:636-544-3908
Mailing Address - Street 1:113 WOODLINE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2868
Mailing Address - Country:US
Mailing Address - Phone:636-544-3908
Mailing Address - Fax:
Practice Address - Street 1:3769 NEW TOWN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4358
Practice Address - Country:US
Practice Address - Phone:636-544-3908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory