Provider Demographics
NPI:1588302269
Name:PRIME LAB SERVICES
Entity type:Organization
Organization Name:PRIME LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-632-2423
Mailing Address - Street 1:640 E SAINT CHARLES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 E SAINT CHARLES RD STE 101
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2600
Practice Address - Country:US
Practice Address - Phone:630-632-2423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center