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NPI Code Detail

MEDICARE: JUSTICE MED LAB

MEDICARE: JUSTICE MED LAB
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
1291U00000XClinical Medical Laboratory14D0982127IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101629953OTHERILBCBS

General Provider Information

NPI Number : 1336291236
Entity Type Code : Organization
Provider Name (Legal Business Name) : JUSTICE MED LAB
Provider Business Mailing Address
First Line : 9050 W 81ST ST
Second Line :
City : JUSTICE
State : IL
Zip : 60458-1350
Country : US
Telephone Number : 708-594-3500
Fax Number : 708-594-5171
Provider Business Practice Location Address
First Line : 9050 W 81ST ST
Second Line :
City : JUSTICE
State : IL
Zip : 60458-1350
Country : US
Telephone Number : 708-594-3500
Fax Number : 708-594-5171
Authorized Official
Title or Position : MANAGER
Name : THEODORE CHRISTOU
Credential : MD
Telephone Number : 708-563-0330
Provider Enumeration Date : 01/18/2007
Last Update Date : 09/30/2008

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Directions to “JUSTICE MED LAB ” Practice Location

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