Provider Demographics
NPI:1386305407
Name:RT PCR TEST NEAR ME INC
Entity type:Organization
Organization Name:RT PCR TEST NEAR ME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FNU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL WAHED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-928-9007
Mailing Address - Street 1:7124 W 83RD ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-4034
Mailing Address - Country:US
Mailing Address - Phone:708-928-9007
Mailing Address - Fax:708-221-8520
Practice Address - Street 1:7124 W 83RD ST UNIT D
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-4034
Practice Address - Country:US
Practice Address - Phone:708-928-9007
Practice Address - Fax:708-221-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D2246682OtherCLIA CERT OF COMPLIANCE
ILF300828629Medicaid