Provider Demographics
NPI:1972254472
Name:THE NORTHWESTERN LABCO LLC
Entity Type:Organization
Organization Name:THE NORTHWESTERN LABCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-498-6659
Mailing Address - Street 1:1449 S MICHIGAN AVE # 1016
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2810
Mailing Address - Country:US
Mailing Address - Phone:312-584-3088
Mailing Address - Fax:312-210-8021
Practice Address - Street 1:1449 S MICHIGAN AVE # 1016
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2810
Practice Address - Country:US
Practice Address - Phone:312-584-3088
Practice Address - Fax:312-210-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory