MEDICARE: SIMPLE LABORATORIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1023438397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE LABORATORIES LLC

Provider Business Mailing Address
First Line	:	7444 W WILSON AVE STE 111
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4500
Country	:	US
Telephone Number	:	773-775-6697
Fax Number	:	708-831-4257

Provider Business Practice Location Address
First Line	:	7444 W WILSON AVE STE 111
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4500
Country	:	US
Telephone Number	:	773-775-6697
Fax Number	:	773-763-7331

Authorized Official
Title or Position	:	SNR RCM BILLING MANAGER
Name	:	HILDA M TIRADO
Credential	:
Telephone Number	:	773-775-6697

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	01/16/2024

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