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General NPI Number Information
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NPI Number | 1487966834
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Entity Type | Organization
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Legal Business Name | COMPLETE LAB TESTS INC
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 6601 S CASS AVE UNIT F
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City | WESTMONT
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State | IL
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Zip | 60559-3266
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Country | US
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Telephone | 630-312-9502
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Fax | 480-553-8685
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Provider Business Mailing Address
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Address Line | 6601 S CASS AVE UNIT F
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City | WESTMONT
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State | IL
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Zip | 60559-3266
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Country | US
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Telephone | 630-312-9502
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Fax | 480-553-8685
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JASON ECHEVARRIA
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Credential |
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Telephone | 480-352-7070
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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 | IL
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