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General NPI Number Information
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NPI Number | 1760904361
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Entity Type | Organization
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Legal Business Name | ACGT, INC.
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 35 W WALTZ DR
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City | WHEELING
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State | IL
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Zip | 60090-6052
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Country | US
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Telephone | 847-520-9162
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Fax | 847-520-9163
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Provider Business Mailing Address
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Address Line | 35 W WALTZ DR
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City | WHEELING
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State | IL
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Zip | 60090-6052
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Country | US
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Telephone | 847-520-9162
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Fax | 847-520-9163
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | DAVID COOK
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Credential | JD
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Telephone | 847-520-9162
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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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Taxonomy #2
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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