Provider Demographics
NPI:1629400817
Name:HAMMOND COMMUNITY SERVICE LAB LLC
Entity type:Organization
Organization Name:HAMMOND COMMUNITY SERVICE LAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:219-226-3294
Mailing Address - Street 1:837 169TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2035
Mailing Address - Country:US
Mailing Address - Phone:219-226-3294
Mailing Address - Fax:219-228-1558
Practice Address - Street 1:837 169TH ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2035
Practice Address - Country:US
Practice Address - Phone:219-226-3294
Practice Address - Fax:219-228-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty