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General NPI Number Information
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NPI Number | 1154579811
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Entity Type | Organization
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Legal Business Name | ALPHA MEDICAL, LLC
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 8635 LEMONT ROAD
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4805
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Country | US
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Telephone | 630-427-0300
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Fax | 630-427-0302
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Provider Business Mailing Address
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Address Line | 8635 LEMONT ROAD
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4805
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Country | US
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Telephone | 630-427-0300
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Fax | 630-427-0302
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | DR. SAM SHIMI
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Credential | MD
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Telephone | 630-257-9500
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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 | 14D1078862
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License Number State | IL
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