Healthcare Provider Details

I. General information

NPI: 1992492581
Provider Name (Legal Business Name): AUSTIN MEDICAL TESTING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 W LAWRENCE AVE
CHICAGO IL
60630-2940
US

IV. Provider business mailing address

6112 W LAWRENCE AVE
CHICAGO IL
60630-2940
US

V. Phone/Fax

Practice location:
  • Phone: 773-747-7348
  • Fax: 773-496-0133
Mailing address:
  • Phone: 773-747-7348
  • Fax: 773-496-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AMJAD NASER
Title or Position: CEO
Credential:
Phone: 773-747-7348