Medvista Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D2011212 Issued in IL

Legal business name

MEDVISTA LABORATORY INC

Practice address

3138 W Cermak Rd
Suite 103
Chicago, IL 60623-3306

Phone

(773) 762-4331

Fax

(773) 762-4333

NPI assigned

Sep 22, 2010

Last updated

Sep 22, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Mwesigwa, NURSE

Title

President

Phone

(773) 218-1004

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1528376688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3029 E 92ND ST",
            "address_2": "SUITE 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174500",
            "telephone_number": "773-218-1004",
            "fax_number": "773-762-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3138 W CERMAK RD",
            "address_2": "SUITE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233306",
            "telephone_number": "773-762-4331",
            "fax_number": "773-762-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDVISTA LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "MWESIGWA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-218-1004",
        "authorized_official_credential": "NURSE"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D2011212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Sep 22, 2010; 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.