Provider Demographics
NPI:1710234919
Name:GOLDEN QUALITY MEDICAL SERVICE
Entity Type:Organization
Organization Name:GOLDEN QUALITY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST /EKG TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:GOLDEN WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-800-8241
Mailing Address - Street 1:9035 S BURLEY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4460
Mailing Address - Country:US
Mailing Address - Phone:872-800-8241
Mailing Address - Fax:
Practice Address - Street 1:9035 S BURLEY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4460
Practice Address - Country:US
Practice Address - Phone:872-800-8241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory