Provider Demographics
NPI:1679849251
Name:GOPATH LABORATORIES, LLC
Entity Type:Organization
Organization Name:GOPATH LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-588-9935
Mailing Address - Street 1:1359 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4501
Mailing Address - Country:US
Mailing Address - Phone:224-588-9940
Mailing Address - Fax:224-588-9941
Practice Address - Street 1:1000 CORPORATE GROVE DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4550
Practice Address - Country:US
Practice Address - Phone:224-588-9940
Practice Address - Fax:224-588-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory