Provider Demographics
NPI:1497493241
Name:GALILEE MEDICAL CENTER, S.C.
Entity Type:Organization
Organization Name:GALILEE MEDICAL CENTER, S.C.
Other - Org Name:GALILEE BIOMED LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-309-6740
Mailing Address - Street 1:4903 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2548
Mailing Address - Country:US
Mailing Address - Phone:773-237-0755
Mailing Address - Fax:773-237-0785
Practice Address - Street 1:4200 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5010
Practice Address - Country:US
Practice Address - Phone:773-295-7300
Practice Address - Fax:773-295-7335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALILEE MEDICAL CENTER, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory