Healthcare Provider Details

I. General information

NPI: 1487308516
Provider Name (Legal Business Name): S.G.C TRANSPORTATION L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6039 S CARPENTER ST
CHICAGO IL
60621-1413
US

IV. Provider business mailing address

14901 COTTAGE GROVE AVE
DOLTON IL
60419-2109
US

V. Phone/Fax

Practice location:
  • Phone: 312-874-2142
  • Fax:
Mailing address:
  • Phone: 312-874-2142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY HOLMES
Title or Position: OWNER
Credential:
Phone: 312-874-2142