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NPI Code Detail

MEDICARE: SPECIAL FRIEND LABORATORY LLC

MEDICARE: SPECIAL FRIEND LABORATORY 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1437778487
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECIAL FRIEND LABORATORY LLC
Provider Business Mailing Address
First Line : 9212 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-359-3373
Fax Number : 773-634-8070
Provider Business Practice Location Address
First Line : 9212 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-359-3373
Fax Number : 773-634-8070
Authorized Official
Title or Position : MANAGER
Name : MS. CAROL A REED
Credential : PHLEBOTOMIST
Telephone Number : 773-359-3373
Provider Enumeration Date : 04/10/2020
Last Update Date : 04/10/2020

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Directions to “SPECIAL FRIEND LABORATORY LLC ” Practice Location

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