SOUTHSHORE MEDI LAB INC (NPI# 1073978631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073978631 |
| Entity Type | Organization |
| Organization Name | SOUTHSHORE MEDI LAB INC |
| Practice Address |
4651 W 79th St Ste 204 Chicago IL 60652-1775 |
| Practice Telephone | 7735850480 |
| Practice Fax Number | 7735850482 |
| Mailing Telephone | 7735850480 |
| Mailing Fax Number | 7735850482 |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2015-12-28 |
| Authorized Official Name | MR. ASHFAQ MUHAMMAD (PRESIDENT) |
| Authorized Official Telephone | 7735850480 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 14D2104608 | IL | Laboratories |
| Street Address |
4651 W 79TH ST STE 204 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60652-1775 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861042715 | New Hope Community Service Center | Clinic/Center | New Hope Community Service Center, 2559 West 79th, Chicago, IL 60652 | 2019-09-12 |
| 1770012189 | Rachel Pasternak | Social Worker | 3348 W 87th Street, Chicago, IL 60652 | 2017-06-08 |
| 1437682283 | Manliu Yang | Dentist | 8541 S Cicero Ave, Chicago, IL 60652 | 2017-04-08 |
| 1336687144 | Stephanie J. Wilson | Registered Nurse | 7600 S. Pulask Rd., Chicago, IL 60652 | 2017-02-01 |
| 1346786811 | Talisha Moman | Licensed Practical Nurse | 7600 S. Pulaski Rd., Suite 1106, Chicago, IL 60652 | 2017-01-09 |
| 1952851933 | Yvonne Caldwell | Licensed Practical Nurse | 8600 S. Pulaski, Road, Chicago, IL 60652 | 2016-10-13 |
| 1942605795 | Brittney Mclean | Developmental Therapist | 4317 W. 77th Pl, Chicago, IL 60652 | 2014-10-22 |
| 1245599521 | Chisa Marie Collins | Occupational Therapist | 8008 S Albany, Chicago, IL 60652 | 2012-05-08 |
| 1548572969 | St. Mary Therapy Services | Clinic/Center | 2455 W 79th St, #101, Chicago, IL 60652 | 2010-07-14 |
| 1750574752 | Curt R Lang | Dentist | 4651 W 79th St, Suite 208, Chicago, IL 60652 | 2007-08-22 |
| Find all providers in zip 60652 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437778487 | Special Friend Laboratory LLC | Clinical Medical Laboratory | 9212 S Commercial Ave, Chicago, IL 60617-4508 | 2020-04-10 |
| 1346886058 | Kc Med Labratory | Clinical Medical Laboratory | 7518 S Ridgeland Ave, Chicago, IL 60649-3907 | 2019-11-18 |
| 1073097184 | 4every1 Lab Inc. | Clinical Medical Laboratory | 10723 S Halsted St, Chicago, IL 60628 | 2018-09-24 |
| 1063991735 | Omni Laboratory Services | Clinical Medical Laboratory | 5862 N Lincoln Ave Ste C2, Chicago, IL 60659-4628 | 2018-08-13 |
| 1992299119 | Lumi Diagnostics LLC | Clinical Medical Laboratory | 2222 W Division St Ste 220, Chicago, IL 60622-3094 | 2018-06-20 |
| 1821526328 | Abc Labs | Clinical Medical Laboratory | 6449 S Pulaski Rd Ste 108, Chicago, IL 60629-5148 | 2017-05-27 |
| 1780132068 | Trisys Medical Group | Clinical Medical Laboratory | 900 N Franklin St Ste 407, Chicago, IL 60610-3168 | 2016-09-15 |
| 1699222000 | Acculab Medical Testing Inc | Clinical Medical Laboratory | 2600 S Michigan Ave Ste 212, Chicago, IL 60616-2859 | 2016-09-01 |
| 1740733708 | Tempus Labs Inc. | Clinical Medical Laboratory | 600 W Chicago Ave Ste 510, Chicago, IL 60654 | 2016-07-26 |
| 1639596802 | New Glance Ltd | Clinical Medical Laboratory | 7741 S Western Ave, Chicago, IL 60620-5821 | 2014-03-25 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.