Medicare Laboratory Services LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MEDICARE LABORATORY SERVICES LLC

Practice address

5659 N Lincoln Ave
Chicago, IL 60659-4957

Phone

(773) 414-9035

NPI assigned

Sep 29, 2021

Organization subpart

No

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

Authorized official

Name

Ayesha Khan

Title

President

Phone

(773) 414-9035

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1780356725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5659 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594957",
            "telephone_number": "773-414-9035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5659 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594957",
            "telephone_number": "773-414-9035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICARE LABORATORY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-29",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "AYESHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-414-9035"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Chicago, IL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.