SPRINGFIELD PEDIATRIC & ADOLESCENT CTR LAB (NPI# 1093973182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093973182 |
| Entity Type | Organization |
| Organization Name | SPRINGFIELD PEDIATRIC & ADOLESCENT CTR LAB |
| Practice Address |
2532 Farragut Dr Springfield IL 62704-1433 |
| Mailing Address |
1025 South 6th Street Springfield IL 62703-2403 |
| Practice Telephone | 2175287541 |
| Mailing Telephone | 2175287541 |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2017-07-26 |
| Authorized Official Name | MR. ALAN NERONE (SENIOR VICE PRESIDENT & CFO) |
| Authorized Official Telephone | 2175287541 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPRINGFIELD CLINIC, LLP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CLIA | 14D0435928 | 01 |
| Street Address |
2532 FARRAGUT DR |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62704-1433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376529917 | Penny S. Fricke | Clinical Nurse Specialist | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2005-12-15 |
| 1316330582 | Leslie K Farris | Nurse Practitioner | 2532 Farragut Dr, Springfield, IL 62704 | 2015-03-12 |
| 1649436809 | Purvi Patel Bhandari | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2008-08-06 |
| 1013126317 | Claudine Gillison | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2007-05-22 |
| 1053461657 | Misty M. Phillips | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2007-01-12 |
| 1184795940 | Gretchen Suzanne Gibbs | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2006-11-13 |
| 1003917089 | Stephanie E. Wojtowicz | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2006-09-25 |
| 1548360134 | Stephen E. Wallace | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2006-09-23 |
| 1023118718 | Susan M. Soler | Pediatrics | 2532 Farragut Dr, Springfield, IL 62704-1433 | 2006-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
| 1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
| 1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
| 1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
| 1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
| 1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
| Find all providers in zip 62704 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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| 1235613712 | Identi-check, Inc | Clinical Medical Laboratory | 3 N Old State Capitol Plz, Springfield, IL 62701-1313 | 2018-09-20 |
| 1659738631 | Dynamic Dna Laboratories, LLC | Clinical Medical Laboratory | 2144 E Republic Rd, Suite B204, Springfield, MO 65804-4623 | 2016-01-21 |
| 1790170447 | Labworks LLC | Clinical Medical Laboratory | 6412 Brandon Ave Ste 342, Springfield, VA 22150-2513 | 2015-03-31 |
| 1235413428 | Labone LLC | Clinical Medical Laboratory | 1242 E Independence St Ste 200, Springfield, MO 65804-4284 | 2011-10-06 |
| 1689966038 | Springfield Clinic Soga Lab | Clinical Medical Laboratory | 900 N 1st St Fl 1, Springfield, IL 62702-3749 | 2011-05-04 |
| 1891023164 | Illinois Department of Public Health | Clinical Medical Laboratory | 525 West Jefferson, 1st Floor, Springfield, IL 62761 | 2009-11-25 |
| 1124286976 | Springfield Clinic Hematology Oncology Lab | Clinical Medical Laboratory | 900 N 1st St Fl 4, Springfield, IL 62702-3749 | 2008-05-29 |
| 1992925580 | Illinois Department of Public Health | Clinical Medical Laboratory | 825 N Rutledge St, Springfield, IL 62702-4910 | 2007-04-26 |
| 1205975174 | Tri-lakes Pathology Services,l.l.c. | Clinical Medical Laboratory | 1000 E Primrose St Ste 300, Springfield, MO 65807-5178 | 2007-02-06 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62704 |
Please comment or provide details below to improve the information on SPRINGFIELD PEDIATRIC & ADOLESCENT CTR LAB.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.