Central Regional Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CENTRAL REGIONAL LABORATORIES, LLC

Practice address

9730 S Western Ave
Suite 706
Evergreen Park, IL 60805-2814

Phone

(708) 952-0931

Fax

(708) 933-4321

NPI assigned

Jun 5, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Bridget P Ross, J.D.

Title

Member

Phone

(708) 952-0931

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1700266566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9730 S WESTERN AVE",
            "address_2": "SUITE 706",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052814",
            "telephone_number": "708-952-0931",
            "fax_number": "708-933-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9730 S WESTERN AVE",
            "address_2": "SUITE 706",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052814",
            "telephone_number": "708-952-0931",
            "fax_number": "708-933-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL REGIONAL LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "708-952-0931",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID NUMBER",
            "identifier": "14D2101796",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Evergreen Park, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; 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.