Medstar Laboratory, Inc
Organization Active NPI Clinical Medical Laboratory · Hillside, IL
NPI 1144202003 · NPPES record last updated Sep 17, 2015
Key facts
- NPI
- 1144202003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 14D0945905 (IL)
- Legal business name
- MEDSTAR LABORATORY, INC
- Practice address
- 4531 Harrison St
Hillside, IL 60162-1614 - Phone
- (708) 488-1000
- Fax
- (708) 488-1831
- NPI assigned
- Nov 16, 2005
- Organization subpart
- No
Authorized official
- Name
- Raj N Patel
- Title
- Vice President
- Phone
- (708) 488-1000
Member organizations 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0945905 | Medstar Laboratory Inc | Compliance | Jul 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100109000082 | IL | Part B Supplier - Independent Clinical Laboratory | 8729129952 | Practice locations: Hillside, IL |
National Provider Directory
Locations
4531 Harrison St
Hillside, IL 60162
Phone (708) 488-1000
1809 Sheridan Rd
North Chicago, IL 60064
Phone (847) 785-0611
7716 Madison St
River Forest, IL 60305
Phone (708) 488-1000
270 E 90th Dr
Ste 2E
Merrillville, IN 46410
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 14D0945905 | IL | Yes |
Addresses
Primary practice location
4531 Harrison St
Hillside, IL 60162-1614
Mailing address
4531 Harrison St
Hillside, IL 60162-1614
Phone (708) 488-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144202003 | Other | NPI | |
| 506110 | Other | PTAN |
Other providers in Hillside, IL
- Kory Marken
- Nicole Martinez
- Christian Jeff Bagnas Matias
- Sarah Mazur
- Jennifer Bonny McQuillan
- Medwest Associates
- MH Health Care Services, PC
- Annie Mo
- Felix Rodrigo Monroy
- Namm Partners, Inc.
All providers in Hillside, IL · Clinical Medical Laboratory in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.