Provider Demographics
NPI:1417904285
Name:ALVERNO CLINICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:ALVERNO CLINICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-989-3714
Mailing Address - Street 1:2434 INTERSTATE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-3361
Mailing Address - Country:US
Mailing Address - Phone:219-989-3700
Mailing Address - Fax:219-989-3900
Practice Address - Street 1:2434 INTERSTATE PLAZA DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-3361
Practice Address - Country:US
Practice Address - Phone:219-989-3700
Practice Address - Fax:219-989-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00263555OtherMEDICARE RAILROAD PIN
IL=========002Medicaid
P00263555OtherMEDICARE RAILROAD PIN