Provider Demographics
NPI:1609026111
Name:ALVERNO CLINICAL LABORATORIES, LLC - WELLGROUP
Entity Type:Organization
Organization Name:ALVERNO CLINICAL LABORATORIES, LLC - WELLGROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-989-3857
Mailing Address - Street 1:333 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1748
Mailing Address - Country:US
Mailing Address - Phone:708-756-0100
Mailing Address - Fax:708-756-7884
Practice Address - Street 1:333 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1748
Practice Address - Country:US
Practice Address - Phone:708-756-0100
Practice Address - Fax:708-756-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory