PATHSOURCE DIAGNOSTICS, LLC (NPI# 1104268622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104268622 |
| Entity Type | Organization |
| Organization Name | PATHSOURCE DIAGNOSTICS, LLC |
| Practice Address |
801 Illini Dr Silvis IL 61282-1804 |
| Mailing Address |
Po Box 144333 Orlando FL 32814-4333 |
| Practice Telephone | 3092814812 |
| Practice Fax Number | 3092814809 |
| Mailing Telephone | 4074229831 |
| Mailing Fax Number | 4072061767 |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2013-07-25 |
| Authorized Official Name | DR. STANLEY T LEUNG (PRESIDENT) |
| Authorized Official Telephone | 3092814812 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | PATHSOURCE DIAGNOSTICS, LLC | Attention Department of Pathology, 1227 E Rusholme St, Davenport, IA 52803 |
| Street Address |
801 ILLINI DR |
| City | SILVIS |
| State | IL |
| Zip Code | 61282-1804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245224310 | Leighton V Arcenas | Internal Medicine | 801 Illini Dr, Silvis, IL 61282-1804 | 2005-09-06 |
| 1215550066 | Ndieme Ndoye | Nurse Practitioner | 801 Illini Dr, Silvis, IL 61282-1804 | 2020-05-27 |
| 1558996942 | Marceline Kougbani-sebou | Nurse Practitioner | 801 Illini Dr, Silvis, IL 61282-1804 | 2020-03-06 |
| 1417417650 | Nichole R Schold | Nurse Practitioner | 801 Illini Dr, Silvis, IL 61282-1804 | 2019-03-22 |
| 1023529252 | Payal Shah | Physician Assistant | 801 Illini Dr, Silvis, IL 61282-1804 | 2017-10-16 |
| 1295254175 | Ian Hart | Physician Assistant | 801 Illini Dr, Silvis, IL 61282-1804 | 2017-09-12 |
| 1376922930 | Muhammad Kumail Shah | Family Medicine | 801 Illini Dr, Silvis, IL 61282 | 2015-05-28 |
| 1144596743 | Samir M Mahfouz | Anesthesiology | 801 Illini Dr, Silvis, IL 61282-1804 | 2012-03-28 |
| 1164721429 | Heng Wu | Anesthesiology | 801 Illini Dr, Silvis, IL 61282-1804 | 2011-03-24 |
| 1699081042 | Geoffrey Michael Giordano | Emergency Medicine | 801 Illini Dr, Silvis, IL 61282-1804 | 2010-08-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174172605 | Phyllis Cunningham | Technician | 603 2nd Ave C, Silvis, IL 61282 | 2019-09-07 |
| 1710369400 | Krystle Lee Hergert | Dietitian, Registered | 2001 5th Street, Silvis, IL 61282 | 2015-06-18 |
| 1558549469 | Bobb Chiropractic Center P.C. | Chiropractor | 813 1st Avenue, Silvis, IL 61282 | 2008-02-01 |
| 1952509846 | Jennifer Marie Jensen | Pharmacist | 1601 18th St, Silvis, IL 61282 | 2007-07-03 |
| 1871516781 | Joseph R Yates | Emergency Medicine | 801 Illini Drive, Silvis, IL 61282 | 2006-07-25 |
| 1376581447 | Holly S Wilkinson | Physical Therapist | 902 Illini Drive, Silvis, IL 61282 | 2006-06-02 |
| 1831145507 | American Drug Stores LLC | Durable Medical Equipment & Medical Supplies | 1312 John Deere Expy, Silvis, IL 61282 | 2006-05-25 |
| 1194326017 | Paul Garner | Pharmacist | 2001 5th St, Silvis, IL 61282 | 2020-11-06 |
| 1366043291 | Karen Marie Garner | Pharmacist | 2001 5th Street, Silvis, IL 61282 | 2020-11-06 |
| 1659865848 | Njl Chiropractic | Clinic/Center | 813 1st Ave, Silvis, IL 61282 | 2018-06-20 |
| Find all providers in zip 61282 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417181686 | Paul Joseph Dimaggio | Pathology | 855 Illini Dr Ste 203, Silvis, IL 61282-2904 | 2009-05-04 |
| 1821099490 | Karen Marie Fitzsimmons | Pathology | 855 Illini Dr, Suite 203, Silvis, IL 61282-2907 | 2005-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255930145 | Uttamjot Kaur | Pathology | 2650 Ridege Avenue, Evanston Hospital, Chicago, IL 60613-6061 | 2020-10-21 |
| 1770131831 | Reditus Laboratories | Pathology | 1805 Riverway Dr, Pekin, IL 61554-9309 | 2019-08-30 |
| 1679137756 | Hans-magne Hansen Hamnvag | Pathology | 2460 S 1st Avenue Loyola University Medical Center, Maywood, IL 60153-3328 | 2019-04-24 |
| 1497229157 | Almasri Medical LLC | Pathology | 8150 185th St Ste A, Tinley Park, IL 60487-9319 | 2019-01-16 |
| 1689188062 | Karina Colossi Furlan | Pathology | 1750 W Harrison St Fl 5, Chicago, IL 60612-3825 | 2017-11-21 |
| 1245753961 | Ayse Irem Kilic | Pathology | 2160 South First Ave., Maywood, IL 60153-3328 | 2017-07-25 |
| 1073967162 | Lucy Fu | Pathology | 303 East Chicago Avenue Ward 3-140 W127, Chicago, IL 60611-1059 | 2016-04-14 |
| 1679930457 | Lindsay Alpert | Pathology | 150 Harvester Drive, Suite 300, Burr Ridge, IL 60527-6686 | 2016-01-25 |
| 1831573898 | Indu Agarwal | Pathology | 2100 Valencia Dr, #314b, Northbrook, IL 60062-7063 | 2015-07-18 |
| 1053790113 | Lisa Han | Pathology | 5841 S. Maryland Ave., Rm. S323, Mc 3083, Chicago, IL 60637-1470 | 2015-05-22 |
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| 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.