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General NPI Number Information
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NPI Number | 1134872500
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Entity Type | Organization
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Legal Business Name | SOUTHWEST LAB CORP
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 504 GLENN AVE STE A
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City | WHEELING
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State | IL
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Zip | 60090-6016
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Country | US
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Telephone | 773-991-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 504 GLENN AVE STE A
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City | WHEELING
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State | IL
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Zip | 60090-6016
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Country | US
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Telephone | 773-991-8205
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AZEEM AYOOB
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Credential |
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Telephone | 773-991-8205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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