Provider Demographics
NPI:1144213885
Name:LIFESCAN LABORATORY, INC.
Entity Type:Organization
Organization Name:LIFESCAN LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSHITZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:847-663-8300
Mailing Address - Street 1:5255 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1106
Mailing Address - Country:US
Mailing Address - Phone:847-663-8300
Mailing Address - Fax:847-663-1977
Practice Address - Street 1:5255 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1106
Practice Address - Country:US
Practice Address - Phone:847-663-8300
Practice Address - Fax:847-663-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherINSURANCE PROVIDER#
IL=========001Medicaid
IL=========OtherINSURANCE PROVIDER#