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General NPI Number Information
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NPI Number | 1760258149
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Entity Type | Organization
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Legal Business Name | SERVIAM DIAGNOSTICS LAB LLC
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 2250 E DEVON AVE STE 328
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City | DES PLAINES
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State | IL
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Zip | 60018-4529
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Country | US
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Telephone | 773-527-0600
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Fax | 470-297-5495
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Provider Business Mailing Address
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Address Line | 6299 NALL AVE STE 200
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City | MISSION
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State | KS
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Zip | 66202-3547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PATRICK ONEILL
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Credential |
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Telephone | 773-527-0600
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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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