Provider Demographics
NPI:1942013602
Name:FERTILITY LAB SCIENCES OF MINNEAPOLIS, LLC
Entity type:Organization
Organization Name:FERTILITY LAB SCIENCES OF MINNEAPOLIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGED CARE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RAVECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-305-6640
Mailing Address - Street 1:9380 STATION ST STE 425
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6565 FRANCE AVE S STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-225-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory