Southshore Medi Lab Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D2104608 Issued in IL

Legal business name

SOUTHSHORE MEDI LAB INC

Practice address

4651 W 79TH St Ste 204
Chicago, IL 60652-1775

Phone

(773) 585-0480

Fax

(773) 585-0482

NPI assigned

Dec 28, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Ashfaq Muhammad

Title

President

Phone

(773) 585-0480

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1451260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451260800000",
    "number": "1073978631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 W 79TH ST STE 204",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606521775",
            "telephone_number": "773-585-0480",
            "fax_number": "773-585-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 W 79TH ST STE 204",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606521775",
            "telephone_number": "773-585-0480",
            "fax_number": "773-585-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSHORE MEDI LAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-28",
        "last_updated": "2015-12-28",
        "status": "A",
        "authorized_official_last_name": "MUHAMMAD",
        "authorized_official_first_name": "ASHFAQ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-585-0480",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D2104608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southpoint Nursing and Rehabilitation Center LLC
• Southport Eye Associates LTD (Custom Eyes)
• Southport Grace Chiropractic and Wellness LLC
• Southport Grace Wellness Center LTD.
• Southshore Care Center, LLC (South Shore Nursing & Rehab Center)
• Southside Family Medicine PC
• Southside Health Association
• Southside Primary Care Group SC (Metro Medical Associates)
• Southtown Medical Center, LLC
• Southview Manor Operator LLC

• Clinical Medical Laboratory in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; 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.