Provider Demographics
NPI:1528294600
Name:ADVANCED LABS, LLC
Entity type:Organization
Organization Name:ADVANCED LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAUSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-469-6200
Mailing Address - Street 1:12855 N 40 DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-469-6200
Mailing Address - Fax:314-469-6206
Practice Address - Street 1:12855 N 40 DR
Practice Address - Street 2:SUITE 275
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:314-469-6200
Practice Address - Fax:314-469-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory