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General NPI Number Information
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NPI Number | 1255086419
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Entity Type | Organization
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Legal Business Name | MS INJECTION INC
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 10/05/2025
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Provider Practice Location Address
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Address Line | 6338 W GUNNISON ST
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City | CHICAGO
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State | IL
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Zip | 60630-2954
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Country | US
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Telephone | 773-553-9648
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Fax |
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Provider Business Mailing Address
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Address Line | 6338 W GUNNISON ST
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City | CHICAGO
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State | IL
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Zip | 60630-2954
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Country | US
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Telephone | 773-553-9648
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | MRS. NICOLE MCCULLOUGH
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Credential |
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Telephone | 773-553-9648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #2
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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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