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General NPI Number Information
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NPI Number | 1821376294
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Entity Type | Organization
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Legal Business Name | GO LABS
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 4106 PHILLIP DR
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City | ZION
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State | IL
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Zip | 60099-9204
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Country | US
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Telephone | 224-789-8076
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Fax | 928-222-3678
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Provider Business Mailing Address
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Address Line | 4106 PHILLIP DR
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City | ZION
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State | IL
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Zip | 60099-9204
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Country | US
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Telephone | 224-789-8076
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Fax | 928-222-3678
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Authorized Official
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Title or Position | OWNER/PHLEBOTOMIST
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Name | MRS. TOYA T SPROUL
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Credential | GEN PTR, PBT
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Telephone | 224-789-8076
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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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