SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB (NPI# 1649409749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649409749 |
| Entity Type | Organization |
| Organization Name | SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB |
| Practice Address |
15 Founders Ln Jacksonville IL 62650-3919 |
| Mailing Address |
1025 South 6th Street Springfield IL 62703-2403 |
| Practice Telephone | 2175287541 |
| Mailing Telephone | (217) 528-7541 |
| Enumeration Date | 2009-07-09 |
| 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 | 14D1097569 | 01 |
| Street Address |
15 FOUNDERS LN |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-3919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487609640 | Kim Wyatt | Family Medicine | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2006-05-24 |
| 1144850769 | Melinda J Dorsey | Registered Nurse | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2020-01-23 |
| 1578115390 | Doug R Mckain | Nurse Practitioner | 15 Founders Ln, Jacksonville, IL 62650 | 2019-07-11 |
| 1265901227 | Lisa J. Lyons | Physician Assistant | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2018-11-20 |
| 1528518602 | Agnes A. Fenner | Nurse Practitioner | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2016-10-12 |
| 1285184713 | Kaitlyn Renee Davidson | Nurse Practitioner | 15 Founders Ln, Jacksonville, IL 62650 | 2016-10-07 |
| 1538518709 | Natalie Mahoney | Family Medicine | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2016-06-08 |
| 1194196493 | Molly Taylor | Nurse Practitioner | 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 | 2015-10-13 |
| 1497131072 | Braden G. Anderson | Optometrist | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2015-08-05 |
| 1083020903 | Coral Jeanne Armour | Social Worker | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2014-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285252601 | Patient Care Labatories, Inc | Clinical Medical Laboratory | 6950 Philips Hwy Ste 36, Jacksonville, FL 32216-6086 | 2020-07-13 |
| 1770137754 | River Town Diagnostics LLC | Clinical Medical Laboratory | 8563 Argyle Business Loop Ste 5, Jacksonville, FL 32244-6613 | 2019-07-29 |
| 1982193330 | Superior Clinical Labs, LLC | Clinical Medical Laboratory | 7685 103rd St Ste 1a, Jacksonville, FL 32210-9326 | 2018-05-01 |
| 1942716378 | Mccall & Erler, LLC | Clinical Medical Laboratory | 3604 University Blvd S Ste 103, Jacksonville, FL 32216-4209 | 2017-12-21 |
| 1952825481 | First Coast Laboratories | Clinical Medical Laboratory | 6900 Southpoint Dr N Ste 100, Jacksonville, FL 32216-8008 | 2017-07-26 |
| 1750839262 | Ace Biomedical Labs, LLC | Clinical Medical Laboratory | 3726 Beach Blvd, Jacksonville, FL 32207-3814 | 2016-09-13 |
| 1700255841 | First Coast Pathology Associates, LLC | Clinical Medical Laboratory | 9421 Waypoint Place, Jacksonville, FL 32257 | 2015-09-18 |
| 1396074720 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 8384 Baymeadows Rd Ste 1b, Jacksonville, FL 32256-7486 | 2009-12-14 |
| 1407016645 | University of Florida Jacksonville Physicians Inc | Clinical Medical Laboratory | 655 W 11th St, Jacksonville, FL 32206-3516 | 2008-06-11 |
| 1174558431 | Florida Department of Health | Clinical Medical Laboratory | 1217 Pearl St, Jacksonville, FL 32202-3926 | 2006-07-12 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
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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.