Evergreen Sheridan Laboratories LTD

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EVERGREEN SHERIDAN LABORATORIES LTD

Practice address

9760 S Kedzie Ave
Evergreen Park, IL 60805

Phone

(708) 423-2660

Fax

(708) 423-1960

NPI assigned

Aug 8, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Karen A Jutzi, LAB TECHNOLOGIST

Title

Owner

Phone

(708) 423-2660

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1972513661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9760 S KEDZIE AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "60805",
            "telephone_number": "708-423-2660",
            "fax_number": "708-423-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9760 S KEDZIE AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "60805",
            "telephone_number": "708-423-2660",
            "fax_number": "708-423-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SHERIDAN LABORATORIES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "JUTZI",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-423-2660",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LAB TECHNOLOGIST"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "50000044",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Carl Anthony Fabiszak, RPH

• Clinical Medical Laboratory in Evergreen Park, IL
• Providers in Evergreen Park, 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 Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.