NPIMap

Organization Active NPI

Omni Laboratory Services

  • Clinical Medical Laboratory
  • Chicago, IL
National Provider Identifier
1063991735
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
OMNI LABORATORY SERVICES
Practice address
5866 N Lincoln Ave
Ste 103
Chicago, IL 60659-4632
Phone
(773) 200-8059
NPI assigned
Aug 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gulam Taha Siddique
Title
Manager
Phone
(773) 200-8059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

5866 N Lincoln Ave
Ste 103
Chicago, IL 60659-4632

Mailing address

5866 N Lincoln Ave
Ste 103
Chicago, IL 60659-4632
Phone (773) 200-8059

National Provider Directory

National Provider Directory
Tax ID family
Omni Diagnostic Laboratory Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1063991735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5866 N LINCOLN AVE",
            "address_2": "STE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594632",
            "telephone_number": "773-200-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5866 N LINCOLN AVE",
            "address_2": "STE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594632",
            "telephone_number": "773-200-8059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI LABORATORY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUE",
        "authorized_official_first_name": "GULAM TAHA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-200-8059"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.