Provider Demographics
NPI:1154579811
Name:ALPHA MEDICAL, LLC
Entity type:Organization
Organization Name:ALPHA MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-257-9500
Mailing Address - Street 1:8635 LEMONT ROAD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4805
Mailing Address - Country:US
Mailing Address - Phone:630-427-0300
Mailing Address - Fax:630-427-0302
Practice Address - Street 1:8635 LEMONT ROAD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4805
Practice Address - Country:US
Practice Address - Phone:630-427-0300
Practice Address - Fax:630-427-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D1078862291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory