MEDICARE: PARK AND TEST 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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1891304259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK AND TEST LLC

Provider Business Mailing Address
First Line	:	1400 PATRIOT BLVD UNIT 526
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-7702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-2713
Country	:	US
Telephone Number	:	847-607-1879
Fax Number	:

Authorized Official
Title or Position	:	TECHNICIAN
Name	:	EDWARD JARMAN
Credential	:	CPT
Telephone Number	:	847-607-1879

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	07/30/2020

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