PREMIER PATHOLOGY SERVICES LLC (NPI# 1306834346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306834346 |
| Entity Type | Organization |
| Organization Name | PREMIER PATHOLOGY SERVICES LLC |
| Practice Address |
211 S 3rd St Dept. of Pathology Belleville IL 62220-1915 |
| Mailing Address |
Po Box 144333 Orlando FL 32814-4333 |
| Practice Telephone | 6182342120 |
| Practice Fax Number | 6182224630 |
| Mailing Telephone | 4074229831 |
| Mailing Fax Number | 4076482065 |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2008-09-03 |
| Authorized Official Name | DOLPH D HAEGE (PRESIDENT) |
| Authorized Official Telephone | 6182342120 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
========= | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE RAILROAD | DD7836 | 01 |
| IL | ADVANTRA PIN | 241644 | 01 |
| IL | CMR PIN | 241644 | 01 |
| MO | 507261808 | 05 | |
| IL | BCBS IL PIN | 08232162 | 01 |
| IL | HEALTHLINK PIN | 717892 | 01 |
| IL | GHP PIN | 241644 | 01 |
| Street Address |
211 S 3RD ST DEPT. OF PATHOLOGY |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62220-1915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851397319 | Ravi Kumar | Specialist | 211 S 3rd St, Belleville, IL 62220-1915 | 2005-06-21 |
| 1720590045 | Cep America - Illinois Snf, LLP | Internal Medicine | 211 S 3rd St, Belleville, IL 62220-1915 | 2017-10-26 |
| 1336670454 | Therese Krause | Nurse Practitioner | 211 S 3rd St, Belleville, IL 62220-1915 | 2017-03-21 |
| 1578920591 | Paul Lee | Registered Nurse | 211 S 3rd St, Operating Room, Belleville, IL 62220-1915 | 2016-01-21 |
| 1417326430 | Lynlee Barnhart | Nurse Practitioner | 211 S 3rd St, Belleville, IL 62220-1915 | 2015-09-21 |
| 1518346634 | Jared Sheley | Pharmacist | 211 S 3rd St, Belleville, IL 62220-1915 | 2015-05-21 |
| 1952792665 | Tracie Kloeppel | Nurse Anesthetist, Certified Registered | 211 S 3rd St, Belleville, IL 62220-1915 | 2015-02-17 |
| 1184022352 | Kristopher Clements | Nurse Anesthetist, Certified Registered | 211 S 3rd St, Belleville, IL 62220-1915 | 2014-12-19 |
| 1518362946 | Amanda Patterson | Nurse Practitioner | 211 S 3rd St, Belleville, IL 62220-1915 | 2014-10-28 |
| 1194124032 | Sharon Faye Haege | Registered Nurse | 211 S 3rd St, Belleville, IL 62220-1915 | 2014-08-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144729716 | St. Elizabeth's Hospital of The Hospital Sisters of The Third Order Of | Clinic/Center | 180 South Third Street Suite 101, Belleville, IL 62220 | 2018-02-08 |
| 1437675535 | Prorehab PC | Occupational Therapist | 1915 Carlyle Ave, Ste D, Belleville, IL 62220 | 2017-08-21 |
| 1629527650 | Arika Forrest | Nurse Practitioner | 140 Iowa Ave, Belleville, IL 62220 | 2016-10-03 |
| 1861861403 | Belleville Endoscopy LLC | Internal Medicine | 311 West Lincoln St, Suite 101, Belleville, IL 62220 | 2015-09-24 |
| 1962871558 | Antony Frierdich | Specialist/Technologist | 22 South 13th Street, Belleville, IL 62220 | 2015-09-24 |
| 1588032858 | Dana Wright | Pharmacist | 211 South Thrid Street, Belleville, IL 62220 | 2015-09-03 |
| 1629208731 | Lisa Marlow Johnson | Developmental Therapist | 34 Fenwood Dr, Belleville, IL 62220 | 2009-07-23 |
| 1841361623 | Neurological Surgery of Belleville | Neurological Surgery | 340 West Lincoln Street, Suite 540, Belleville, IL 62220 | 2006-11-13 |
| 1689769119 | Kathy Jo Corn | Counselor | 521 W. Main, Suite 201 B, Belleville, IL 62220 | 2006-10-03 |
| 1780609578 | Southern Illinois Health Care Foundation, Inc. | Counselor | 180 S 3rd St Ste 103&104, Belleville, IL 62220 | 2006-07-13 |
| Find all providers in zip 62220 | ||||
| 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 |
|---|---|---|---|---|
| 1912959206 | Frank Pikul | Pathology | 613 E Waters Edge Dr, Belleville, IL 62221-7815 | 2006-05-16 |
| 1255316725 | Vidya Deshpande | Pathology | 45 Sheffield Drive, Belleville, IL 62243 | 2005-12-07 |
| 1508090051 | Essel Marie B De Leon | Pathology | 1 Clara Maass Dr, Pathology Department, Belleville, NJ 07109-3550 | 2009-05-13 |
| 1932355062 | Allison Taylor Howard | Pathology | 211 S 3rd St, Belleville, IL 62220-1915 | 2008-08-08 |
| 1760663942 | Stephen Michael Olson | Pathology | 211 S 3rd St, Belleville, IL 62220-1915 | 2007-11-16 |
| 1952400061 | John Kopf Donahue | Pathology | 1 Clara Maass Dr, Belleville, NJ 07109-3550 | 2006-09-22 |
| 1487764890 | Christopher Murphy | Pathology | 211 S 3rd St, Belleville, IL 62220-1915 | 2006-08-30 |
| 1841307899 | Alexander David Pederson | Pathology | 211 S 3rd St, Dept of Pathology, Belleville, IL 62220-1915 | 2006-08-24 |
| 1104835842 | Ram Sai Bala | Pathology | 211 S 3rd St, Dept. of Pathology, Belleville, IL 62220-1915 | 2006-08-05 |
| 1417973595 | Robert Charles Benedetti | Pathology | 1 Clara Maass Dr, Belleville, NJ 07109-3550 | 2006-07-14 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62220 |
Please comment or provide details below to improve the information on PREMIER PATHOLOGY SERVICES LLC.
| 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.