Provider Demographics
NPI:1326708694
Name:ACE CLINICAL EXPERTS LLC
Entity Type:Organization
Organization Name:ACE CLINICAL EXPERTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-999-6071
Mailing Address - Street 1:1440 W TAYLOR ST # 1105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:773-999-6071
Mailing Address - Fax:
Practice Address - Street 1:2800 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1908
Practice Address - Country:US
Practice Address - Phone:773-999-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service