Provider Demographics
NPI:1891062287
Name:LAB EXPRESS CORPORATION
Entity Type:Organization
Organization Name:LAB EXPRESS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:708-907-5694
Mailing Address - Street 1:9243 S ROBERTS RD
Mailing Address - Street 2:2R
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2079
Mailing Address - Country:US
Mailing Address - Phone:708-907-5694
Mailing Address - Fax:708-907-5696
Practice Address - Street 1:5000 W 95TH ST STE A
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2402
Practice Address - Country:US
Practice Address - Phone:708-907-5694
Practice Address - Fax:708-907-5696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory