Provider Demographics
NPI:1336838457
Name:CB LABORATORY LLC
Entity Type:Organization
Organization Name:CB LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LABORATORY SCIENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYMIE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:CLS (ASCP)
Authorized Official - Phone:309-291-0899
Mailing Address - Street 1:370 E COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9054
Mailing Address - Country:US
Mailing Address - Phone:309-291-0899
Mailing Address - Fax:309-291-0927
Practice Address - Street 1:370 E COURTLAND ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-9054
Practice Address - Country:US
Practice Address - Phone:309-291-0899
Practice Address - Fax:309-291-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory