A,General Lab Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

A,GENERAL LAB CORP

Practice address

1793 Bloomingdale Rd Ste 1
Glendale Heights, IL 60139-3800

Phone

(630) 933-9373

Fax

(630) 373-4545

NPI assigned

Jun 15, 2007

Last updated

Jun 16, 2008By 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

Ms. Salma Mirza

Title

Office Manager

Phone

(224) 595-5100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1689879249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 BLOOMINGDALE RD STE 1",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601393800",
            "telephone_number": "630-933-9373",
            "fax_number": "630-373-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1793 BLOOMINGDALE RD STE 1",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601393800",
            "telephone_number": "630-933-9373",
            "fax_number": "630-373-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A,GENERAL LAB CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "MIRZA",
        "authorized_official_first_name": "SALMA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "224-595-5100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364296016001",
            "state": "IL"
        }
    ],
    "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 Jun 16, 2008; 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.