Provider Demographics
NPI:1639628225
Name:SCOTTLAB, LTD.
Entity Type:Organization
Organization Name:SCOTTLAB, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAIFAN
Authorized Official - Suffix:
Authorized Official - Credentials:STAFF
Authorized Official - Phone:773-649-3099
Mailing Address - Street 1:71 W 156TH ST STE 206A
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4262
Mailing Address - Country:US
Mailing Address - Phone:773-649-3099
Mailing Address - Fax:773-649-3138
Practice Address - Street 1:71 W 156TH ST STE 206A
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:312-794-7772
Practice Address - Fax:773-649-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2118158207ZP0102X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty