Glass Clinical Labs Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

001 Issued in IL

Legal business name

GLASS CLINICAL LABS INC.

Practice address

18238 Aida CT
Homewood, IL 60430-2867

Phone

(708) 991-0714

NPI assigned

Mar 6, 2007

Last updated

Jul 21, 2022By 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

Dr. Kolavennu V Krishnaiah, PH.D

Title

Director

Phone

(708) 991-0714

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952431538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18238 AIDA CT",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302867",
            "telephone_number": "708-991-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18238 AIDA CT",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302867",
            "telephone_number": "708-991-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLASS CLINICAL LABS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KRISHNAIAH",
        "authorized_official_first_name": "KOLAVENNU",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-991-0714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Homewood, IL
• Providers in Homewood, 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 Jul 21, 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.