Provider Demographics
NPI:1831846443
Name:CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HABEEBUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-705-2301
Mailing Address - Street 1:19255 EVERETT LN STE C
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8870
Mailing Address - Country:US
Mailing Address - Phone:214-705-2301
Mailing Address - Fax:
Practice Address - Street 1:19255 EVERETT LN STE C
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8870
Practice Address - Country:US
Practice Address - Phone:214-705-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory