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General NPI Number Information
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NPI Number | 1710234919
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Entity Type | Organization
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Legal Business Name | GOLDEN QUALITY MEDICAL SERVICE
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9035 S BURLEY AVE SUITE 3
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City | CHICAGO
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State | IL
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Zip | 60617-4460
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Country | US
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Telephone | 872-800-8241
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Fax |
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Provider Business Mailing Address
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Address Line | 9035 S BURLEY
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City | CHICAGO
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State | IL
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Zip | 60617-4460
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Country | US
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Telephone | 872-800-8241
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Fax |
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Authorized Official
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Title or Position | PHLEBOTOMIST /EKG TECH
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Name | MRS. WANDA FAYE GOLDEN WOODS
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Credential |
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Telephone | 872-800-8241
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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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