Provider Demographics
NPI:1457124729
Name:SIMPLE STICKS LABORATORY
Entity type:Organization
Organization Name:SIMPLE STICKS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONEIK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:773-676-0369
Mailing Address - Street 1:4350 211TH ST STE 210A
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3082
Mailing Address - Country:US
Mailing Address - Phone:773-676-0369
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY PLAZA DR STE 501
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2359
Practice Address - Country:US
Practice Address - Phone:773-676-0369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory