MEDICARE: CML-CHICAGO MARKET LABS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	D019131	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000221539	OTHER	IN	ANTHEM
3	21623281	OTHER	IL	BLUE CROSS
4	690008950	OTHER	IL	RAILROAD

General Provider Information

NPI Number	:	1205839115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CML-CHICAGO MARKET LABS, INC.

Provider Business Mailing Address
First Line	:	20 BURTON HILLS BLVD
Second Line	:	ATTN: CAROL BAILEY
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6197
Country	:	US
Telephone Number	:	615-665-6000
Fax Number	:	615-665-6184

Provider Business Practice Location Address
First Line	:	3231 EUCLID AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3471
Country	:	US
Telephone Number	:	708-783-0737
Fax Number	:	708-783-0668

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CAROL A BAILEY
Credential	:
Telephone Number	:	615-665-6000

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/08/2016

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