NPIMap

Organization Active NPI

Springfield Pediatric & Adolescent Ctr Lab

  • Clinical Medical Laboratory
  • Springfield, IL
National Provider Identifier
1093973182
Registry record updated Jul 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SPRINGFIELD PEDIATRIC & ADOLESCENT CTR LAB
Practice address
2532 Farragut Dr
Springfield, IL 62704-1433
Phone
(217) 528-7541
NPI assigned
May 27, 2008
Last updated
Jul 26, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
SPRINGFIELD CLINIC, LLPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2017

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

Authorized official

Name
Mr. Alan Nerone
Title
Senior Vice President & Cfo
Phone
(217) 528-7541

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2532 Farragut Dr
Springfield, IL 62704-1433

Mailing address

1025 South 6TH Street
Springfield, IL 62703-2403
Phone (217) 528-7541

Other identifiers 1

IdentifierTypeStateIssuer
14D0435928OtherCLIA

National Provider Directory

National Provider Directory
Tax ID family
Springfield Clinic Carlinville Lab63 organizations share this tax ID, including this one
Part of
Springfield Clinic Carlinville Lab

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

2532 Farragut Dr
Springfield, IL 62704
Phone (217) 787-9424

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501027200000",
    "number": "1093973182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 SOUTH 6TH STREET",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2532 FARRAGUT DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627041433",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD PEDIATRIC & ADOLESCENT CTR LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPRINGFIELD CLINIC, LLP",
        "enumeration_date": "2008-05-27",
        "last_updated": "2017-07-26",
        "status": "A",
        "authorized_official_last_name": "NERONE",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "217-528-7541",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0435928",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2017; 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.