Prentice Place

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PRENTICE PLACE

Practice address

255 W 112TH PL
Chicago, IL 60628-4132

Phone

(773) 391-3123

Fax

(773) 701-6844

NPI assigned

Nov 26, 2024

Organization subpart

No

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

Authorized official

Name

Prentice A. Earl

Title

Owner

Phone

(773) 391-3123

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Prentice Place2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prentice Place

  • Substance Abuse Rehabilitation Facility
  • Chicago, IL
  • NPI 1548774961
  NPD tax ID

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

{
    "created_epoch": "1732579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1053137760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W 112TH PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606284132",
            "telephone_number": "773-391-3123",
            "fax_number": "773-701-6844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W 112TH PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606284132",
            "telephone_number": "773-391-3123",
            "fax_number": "773-701-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRENTICE PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-26",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "EARL",
        "authorized_official_first_name": "PRENTICE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-391-3123"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaja Lynn Prendergast
• Molly Anne Prendergast, APRN, CNP
• Patricia Anne Prendergast, LCSW
• Hindrik Jan Prenger, DNP, FNP-BC
• Eric H Prensky, PH.D.
• Prentice Place
• Amanda Prentice
• Taniesha Prentice
• David A Prentis, DPT
• Michael Preodor, MD

• Clinical Medical Laboratory in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.