Provider Demographics
NPI:1023592540
Name:SCOTTLAB, LTD.
Entity type:Organization
Organization Name:SCOTTLAB, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KILCOYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-649-3099
Mailing Address - Street 1:71 W 156TH ST STE 206A
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4262
Mailing Address - Country:US
Mailing Address - Phone:773-649-3099
Mailing Address - Fax:773-649-3138
Practice Address - Street 1:71 W 156TH ST STE 206A
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4262
Practice Address - Country:US
Practice Address - Phone:773-649-3099
Practice Address - Fax:773-649-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty