MEDICARE: LITHOLINK CORPORATION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14D1083651	OTHER	IL	CLIA

General Provider Information

NPI Number	:	1205090891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITHOLINK CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 2240
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27216-2240
Country	:	US
Telephone Number	:	800-222-7566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 W HARRISON ST
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60612-4670
Country	:	US
Telephone Number	:	312-243-0600
Fax Number	:

Authorized Official
Title or Position	:	CFO EVP TREASURER
Name	:	MR. WILLIAM B HAYES
Credential	:
Telephone Number	:	800-222-7566

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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Directions to “LITHOLINK CORPORATION ” Practice Location

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