NPIMap

Organization Active NPI

Blue Island Pathology LTD

  • Cytopathology Physician
  • Blue Island, IL
National Provider Identifier
1023041233
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cytopathology PhysicianTaxonomy code 207ZC0500X
Legal business name
BLUE ISLAND PATHOLOGY LTD
Practice address
12935 Gregory St
Blue Island, IL 60406-2428
Phone
(708) 597-2000
NPI assigned
Jul 9, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Patty A Mancuso
Title
Office Manager
Phone
(708) 388-0423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X IL Primary

Addresses

Primary practice location

12935 Gregory St
Blue Island, IL 60406-2428

Mailing address

3300 Burr Oak Ave
2ND Floor
Blue Island, IL 60406-3802
Phone (708) 388-0423

Other identifiers 1

IdentifierTypeStateIssuer
01619974OtherILBCBS OF IL

National Provider Directory

National Provider Directory

Locations

3300 127th St
Blue Island, IL 60406

3300 Burr Oak Ave
Fl 2
Blue Island, IL 60406

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1023041233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 BURR OAK AVE",
            "address_2": "2ND FLOOR",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604063802",
            "telephone_number": "708-388-0423",
            "fax_number": "708-388-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12935 GREGORY ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062428",
            "telephone_number": "708-597-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ISLAND PATHOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MANCUSO",
        "authorized_official_first_name": "PATTY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-388-0423",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "01619974",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Island, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.