Provider Demographics
NPI:1346787264
Name:STOVER DIAGNOSTICS LABORATORIES INC
Entity type:Organization
Organization Name:STOVER DIAGNOSTICS LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-871-8757
Mailing Address - Street 1:1776 CROSSWINDS DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4832
Mailing Address - Country:US
Mailing Address - Phone:855-871-8757
Mailing Address - Fax:866-304-4036
Practice Address - Street 1:1776 CROSSWINDS DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4832
Practice Address - Country:US
Practice Address - Phone:855-871-8757
Practice Address - Fax:866-304-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory