Organization
CENTRAL REGIONAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGET P ROSS J.D. (MEMBER)
(708) 952-0931
Entity
Organization
Contact information
Practice address
9730 S WESTERN AVE, SUITE 706, EVERGREEN PARK, IL 60805-2814
(708) 952-0931
(708) 933-4321
Mailing address
9730 S WESTERN AVE, SUITE 706, EVERGREEN PARK, IL 60805-2814
(708) 952-0931
(708) 933-4321
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D2101796
CLIA ID NUMBER
IL
Enumeration date
06/05/2015
Last updated
10/14/2015
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