Provider Demographics
NPI:1659370047
Name:CMS LABS INC
Entity Type:Organization
Organization Name:CMS LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:847-480-4680
Mailing Address - Street 1:1818 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4106
Mailing Address - Country:US
Mailing Address - Phone:847-656-0194
Mailing Address - Fax:847-714-1615
Practice Address - Street 1:1818 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4106
Practice Address - Country:US
Practice Address - Phone:847-656-0194
Practice Address - Fax:847-714-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D0950557291U00000X
FL10D1044289291U00000X
IL14D1106803291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031322000Medicaid
IL1636252OtherBLUE CROSS BLUE SHEILD
IL=========001Medicaid
FL031322000Medicaid
FLE9180AMedicare PIN
FLE9180Medicare PIN
IL201007Medicare ID - Type UnspecifiedIDTF
ILIL5315Medicare PIN
IL690009277Medicare ID - Type UnspecifiedRAILROAD MEDICARE