Provider Demographics
NPI:1215646278
Name:AJR DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:AJR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:309-696-7777
Mailing Address - Street 1:1805 RIVERWAY DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-9309
Mailing Address - Country:US
Mailing Address - Phone:309-202-7575
Mailing Address - Fax:
Practice Address - Street 1:1805 RIVERWAY DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-9309
Practice Address - Country:US
Practice Address - Phone:309-202-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory