Provider Demographics
NPI:1174266787
Name:GOAT MASS SWABS INC
Entity Type:Organization
Organization Name:GOAT MASS SWABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:FNU
Authorized Official - Middle Name:MIR MOUZAM ALI
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-863-8246
Mailing Address - Street 1:201 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4025
Mailing Address - Country:US
Mailing Address - Phone:630-863-8246
Mailing Address - Fax:
Practice Address - Street 1:201 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4025
Practice Address - Country:US
Practice Address - Phone:630-863-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory