Healthcare Provider Details

I. General information

NPI: 1841314804
Provider Name (Legal Business Name): MEDCO SERVICE ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28835 N HERKY DR STE 102
LAKE BLUFF IL
60044-1465
US

IV. Provider business mailing address

28835 N HERKY DR STE 102
LAKE BLUFF IL
60044-1465
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-3201
  • Fax: 847-362-3202
Mailing address:
  • Phone: 847-362-3201
  • Fax: 847-362-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. PAULA HUFFMAN
Title or Position: OWNER
Credential:
Phone: 847-362-3201