Liberty Mobile Labs Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LIBERTY MOBILE LABS INC

Practice address

541 Spruce Rd
Bolingbrook, IL 60440-2504

Phone

(630) 880-9454

Fax

(630) 596-1404

NPI assigned

Jul 20, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Donald Joseph Hansen, AMCA-PCT 4709NPI 1184100984

Title

Owner

Phone

(630) 880-9517

Specialties & licenses 2

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donald Joseph Hansen, AMCA-4709

  • Clinical Laboratory Director (Non-physician)
  • Bolingbrook, IL
  • NPI 1184100984
  NPD Authorized official
• Jessie Hansen

  • Specialist
  • Bolingbrook, IL
  • NPI 1992179972
  NPD
• Donald Hansen, OWNER

  • Clinical Medical Laboratory
  • Bolingbrook, IL
  • NPI 1720452709
  NPD (past)

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574467200000",
    "number": "1568949758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 SPRUCE RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402504",
            "telephone_number": "630-880-9517",
            "fax_number": "630-596-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 SPRUCE RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402504",
            "telephone_number": "630-880-9454",
            "fax_number": "630-596-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MOBILE LABS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-20",
        "last_updated": "2019-11-23",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-880-9517",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "AMCA-PCT 4709"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Leon, LCSW
• Daniel Joseph Levinthal, MD
• Pamela Yvette Lewis
• Beverly Jane Lezondra, O.D.
• Tehming Liang, M.D.,PHD.
• Allan J Libunao, DDS
• Jefferson James Mahinay Licup, OTR/L
• Life Impact Circles of Wellness
• Adam Michael Likavec, MD
• Michael Likens

• Clinical Medical Laboratory in Bolingbrook, IL
• Providers in Bolingbrook, 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 23, 2019; 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.