Provider Demographics
NPI:1033109897
Name:ASSOCIATED LABORATORY PHYSICIANS SC
Entity Type:Organization
Organization Name:ASSOCIATED LABORATORY PHYSICIANS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-915-5763
Mailing Address - Street 1:PO BOX 74821
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-4821
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-915-5763
Practice Address - Fax:708-915-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619826OtherBCBSIL GROUP NUMBER
IL379820Medicare PIN
1619826OtherBCBSIL GROUP NUMBER
ILCC3182Medicare PIN