Provider Demographics
NPI:1306397104
Name:PAINTOX LLC
Entity Type:Organization
Organization Name:PAINTOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUSHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-932-7242
Mailing Address - Street 1:16604 S. 107TH COURT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8898
Mailing Address - Country:US
Mailing Address - Phone:815-932-7242
Mailing Address - Fax:815-932-7307
Practice Address - Street 1:16604 S. 107TH COURT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8898
Practice Address - Country:US
Practice Address - Phone:815-932-7242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory