Provider Demographics
NPI:1831373836
Name:HEMATOGENIX LABORATORY SERVICES, LLC
Entity type:Organization
Organization Name:HEMATOGENIX LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYTHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-444-0444
Mailing Address - Street 1:8150 185TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-9229
Mailing Address - Country:US
Mailing Address - Phone:708-444-0444
Mailing Address - Fax:708-444-0445
Practice Address - Street 1:8150 185TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9229
Practice Address - Country:US
Practice Address - Phone:708-444-0444
Practice Address - Fax:708-444-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000216216Medicare PIN