Provider Demographics
NPI:1215263702
Name:R LABORATORY INCORPORATED
Entity type:Organization
Organization Name:R LABORATORY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:RONQUILLO
Authorized Official - Last Name:REDRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-493-4111
Mailing Address - Street 1:1127 S MANNHEIM RD STE 215
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2562
Mailing Address - Country:US
Mailing Address - Phone:708-493-4111
Mailing Address - Fax:
Practice Address - Street 1:1127 S MANNHEIM RD STE 215
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2562
Practice Address - Country:US
Practice Address - Phone:708-493-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory