MEDICARE: HEMATOGENIX LABORATORY SERVICES, 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
2	291U00000X	Clinical Medical Laboratory		IL

General Provider Information

NPI Number	:	1831373836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEMATOGENIX LABORATORY SERVICES, LLC

Provider Business Mailing Address
First Line	:	8150 185TH ST
Second Line	:	SUITE A
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-9229
Country	:	US
Telephone Number	:	708-444-0444
Fax Number	:	708-444-0445

Provider Business Practice Location Address
First Line	:	8150 185TH ST
Second Line	:	SUITE A
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-9229
Country	:	US
Telephone Number	:	708-444-0444
Fax Number	:	708-444-0445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HYTHAM AL-MASRI
Credential	:	MD
Telephone Number	:	708-444-0444

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/08/2023

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