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1053819722 NPI number — L. MEDICINE LABS, LLC

NPI Number: 1053819722
Health Care Provider/Practitioner: L. MEDICINE LABS, LLC

Information about “1053819722” NPI (L. MEDICINE LABS, LLC) exists in 1053819722 in HTML format HTML  |  1053819722 in plain Text format TXT  |  1053819722 in PDF (Portable Document Format) PDF  |  1053819722 in an XML format XML  formats.

NPI Number : 1053819722 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053819722",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "L. MEDICINE LABS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2160 S 1ST AVE RM 1711",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAYWOOD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60153-3328",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-216-8686",
    "MailingAddressFaxNumber": "708-216-8059",
    "FirstLinePracticeLocationAddress": "3231 EUCLID AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BERWYN",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60402-3471",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-783-0737",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/29/2018",
    "LastUpdateDate": "01/24/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LUKASICK",
    "AuthorizedOfficialFirstName": "MELISSA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "REGIONAL CHIEF FINANCIAL OFFICER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "708-216-5723",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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