University Lab Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D2142429 Issued in IL

Legal business name

UNIVERSITY LAB CORP

Practice address

603 Country Club Dr Ste E
Bensenville, IL 60106-1329

Phone

(630) 521-9708

Fax

(630) 521-9714

NPI assigned

Mar 1, 2018

Organization subpart

No

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

Authorized official

Name

Sam Shimi

Title

Director of Operations

Phone

(630) 257-9500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1225530678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 COUNTRY CLUB DR STE E",
            "city": "BENSENVILLE",
            "state": "IL",
            "postal_code": "601061329",
            "telephone_number": "630-521-9708",
            "fax_number": "630-521-9714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 COUNTRY CLUB DR STE E",
            "city": "BENSENVILLE",
            "state": "IL",
            "postal_code": "601061329",
            "telephone_number": "630-521-9708",
            "fax_number": "630-521-9714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY LAB CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "SHIMI",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "630-257-9500"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D2142429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D2142429",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Bensenville, IL
• Providers in Bensenville, 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 Nov 15, 2018; 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.