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General NPI Number Information
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NPI Number | 1679234512
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Entity Type | Organization
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Legal Business Name | BULLSEYE TESTING, LLC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 6048 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60636-2304
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Country | US
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Telephone | 708-250-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 900 RIDGE RD STE 1N
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City | HOMEWOOD
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State | IL
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Zip | 60430-1934
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Country | US
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Telephone | 708-250-0013
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JEFFREY STOKES
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Credential |
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Telephone | 708-250-0013
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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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