Basic Information
| Provider Information | |||||||||
| NPI: | 1659354645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STROMSDORFER-TOLOD MEDICAL LAB LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1063 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620021063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148218055 | ||||||||
| FaxNumber: | 3148211833 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 SAINT ANTHONYS WAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620024568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184654511 | ||||||||
| FaxNumber: | 6184746018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | STROMSDORFER | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 6184654511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 036039355 | 05 | IL | MEDICAID | 166253 | 01 | IL | HEALTHLINK | OTHER | 4503813 | 01 | IL | AETNA | OTHER | 50000460 | 01 | IL | BCBS | OTHER | CI7774 | 01 | TRAVELERS | OTHER | 43489 | 01 | IL | GHP | OTHER |