Southwest Lab Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOUTHWEST LAB CORP

Practice address

504 Glenn Ave Ste a
Wheeling, IL 60090-6016

Phone

(773) 991-8205

NPI assigned

Jan 27, 2022

Organization subpart

No

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

Authorized official

Name

Azeem Ayoob

Title

Ceo

Phone

(773) 991-8205

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1643241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1134872500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 GLENN AVE STE A",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600906016",
            "telephone_number": "773-991-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 GLENN AVE STE A",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600906016",
            "telephone_number": "773-991-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LAB CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-27",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "AYOOB",
        "authorized_official_first_name": "AZEEM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-991-8205"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.