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General NPI Number Information
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NPI Number | 1588484083
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Entity Type | Organization
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Legal Business Name | FAIS REFERENCE LABS INC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 475 BROWN BLVD STE 103
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2325
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Country | US
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Telephone | 815-936-8962
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Fax | 815-936-8650
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Provider Business Mailing Address
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Address Line | 475 BROWN BLVD STE 103
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2325
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Country | US
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Telephone | 815-936-8962
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Fax | 815-936-8650
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTY FARMER
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Credential |
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Telephone | 815-937-7962
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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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