Provider Demographics
NPI:1851044333
Name:COVID TESTING CENTERS AND WELLNESS
Entity Type:Organization
Organization Name:COVID TESTING CENTERS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIYM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-997-4546
Mailing Address - Street 1:10158 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1928
Mailing Address - Country:US
Mailing Address - Phone:708-465-2837
Mailing Address - Fax:773-238-5903
Practice Address - Street 1:10158 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1928
Practice Address - Country:US
Practice Address - Phone:708-465-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center