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General NPI Number Information
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NPI Number | 1972513661
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Entity Type | Organization
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Legal Business Name | EVERGREEN SHERIDAN LABORATORIES LTD
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 9760 S KEDZIE AVE
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City | EVERGREEN PARK
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State | IL
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Zip | 60805
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Country | US
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Telephone | 708-423-2660
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Fax | 708-423-1960
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Provider Business Mailing Address
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Address Line | 9760 S KEDZIE AVE
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City | EVERGREEN PARK
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State | IL
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Zip | 60805
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Country | US
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Telephone | 708-423-2660
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Fax | 708-423-1960
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Authorized Official
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Title or Position | OWNER
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Name | MS. KAREN A JUTZI
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Credential | LAB TECHNOLOGIST
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Telephone | 708-423-2660
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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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