1285713826 NPI number — LABORATORY & PATHOLOGY DIAGNOSTICS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285713826 NPI number — LABORATORY & PATHOLOGY DIAGNOSTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORY & PATHOLOGY DIAGNOSTICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285713826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT 4387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60122-4387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-355-0450
Provider Business Mailing Address Fax Number:
630-527-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 S WASHINGTON STREET
Provider Second Line Business Practice Location Address:
EDWARD HOSPITAL
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60566-7060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-355-0450
Provider Business Practice Location Address Fax Number:
630-527-3911
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-730-3843

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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