MEDICARE: HWY CLINICAL LABORATORY SERVICES

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	:	1720206253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HWY CLINICAL LABORATORY SERVICES

Provider Business Mailing Address
First Line	:	3829 S OLD HIGHWAY 94
Second Line	:	SUITE 400
City	:	SAINT PETERS
State	:	MO
Zip	:	63304-2824
Country	:	US
Telephone Number	:	847-704-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 E GOLF RD
Second Line	:	SUITE 2140
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5222
Country	:	US
Telephone Number	:	847-704-2227
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TUM DINH NGUYEN
Credential	:
Telephone Number	:	847-704-2227

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	08/22/2020

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