Healthcare Provider Details

I. General information

NPI: 1114087178
Provider Name (Legal Business Name): CML-CHICAGO MARKET LABS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 EUCLID AVE
BERWYN IL
60402-3471
US

IV. Provider business mailing address

20 BURTON HILLS BLVD SUITE 100, ATTN: CAROL BAILEY
NASHVILLE TN
37215-6197
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-0737
  • Fax: 708-783-0668
Mailing address:
  • Phone: 615-665-6000
  • Fax: 615-665-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberD019131
License Number StateIL

VIII. Authorized Official

Name: CAROL A BAILEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-665-6000