=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861763658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALVERNO LABORATORIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2012
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2434 INTERSTATE PLAZA DR.
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46324-2671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-989-3700
-----------------------------------------------------
Fax | 219-989-3900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2434 INTERSTATE PLAZA DR
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46324-2671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-989-3700
-----------------------------------------------------
Fax | 219-989-3900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO AND PRESIDENT
-----------------------------------------------------
Name | SAM TERESE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-803-4776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------