Provider Demographics
NPI:1871893743
Name:MEDSTOP ONE DIAGNOSTICS LLC
Entity type:Organization
Organization Name:MEDSTOP ONE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-1779
Mailing Address - Street 1:PO BOX 1623
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1623
Mailing Address - Country:US
Mailing Address - Phone:573-335-1779
Mailing Address - Fax:573-335-1772
Practice Address - Street 1:3065 WILLIAM ST
Practice Address - Street 2:STE 211
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6393
Practice Address - Country:US
Practice Address - Phone:573-335-4100
Practice Address - Fax:573-339-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty