SPRINGFIELD CLINIC SOGA LAB (NPI# 1689966038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689966038 |
| Entity Type | Organization |
| Organization Name | SPRINGFIELD CLINIC SOGA LAB |
| Practice Address |
900 N 1st St Fl 1 Springfield IL 62702-3749 |
| Mailing Address |
1025 South 6th Street Springfield IL 62703-2403 |
| Practice Telephone | 2175287541 |
| Mailing Telephone | (217) 528-7541 |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2017-07-25 |
| 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 | 14D0435731 | 01 |
| Street Address |
900 N 1ST ST FL 1 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-3749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| 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 |
|---|---|---|---|---|
| 1104474360 | Mmi Laboratory Services, LLC | Clinical Medical Laboratory | 1927 S National Ave Ste A, Springfield, MO 65804-2279 | 2019-08-30 |
| 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 |
| 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 |
| 1497820435 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc | Clinical Medical Laboratory | 6501 Loisdale Road, Springfield, VA 22150-1845 | 2006-11-22 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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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.