Provider Demographics
NPI:1841314804
Name:MEDCO SERVICE ORGANIZATION
Entity type:Organization
Organization Name:MEDCO SERVICE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-362-3201
Mailing Address - Street 1:28835 N HERKY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1465
Mailing Address - Country:US
Mailing Address - Phone:847-362-3201
Mailing Address - Fax:847-362-3202
Practice Address - Street 1:28835 N HERKY DR STE 102
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1465
Practice Address - Country:US
Practice Address - Phone:847-362-3201
Practice Address - Fax:847-362-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL351500Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER