Comprehensive Hemostasis and Thrombosis Institute

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D0982678 CLIA

Legal business name

COMPREHENSIVE HEMOSTASIS AND THROMBOSIS INSTITUTE

Practice address

4727 N Sheridan Rd
Peoria, IL 61614-5925

Phone

(309) 688-1345

Fax

(309) 688-0917

NPI assigned

Sep 23, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Mary L Davis

Title

Executive Director

Phone

(309) 688-1345

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Comprehensive Hemostasis and Thrombosis Laboratory Doing business as

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218153600000",
    "number": "1194711234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4727 N SHERIDAN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145925",
            "telephone_number": "309-688-1345",
            "fax_number": "309-688-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 N SHERIDAN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145925",
            "telephone_number": "309-688-1345",
            "fax_number": "309-688-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE HEMOSTASIS AND THROMBOSIS INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2008-08-08",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "309-688-1345",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": "14D0982678 CLIA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00115815",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "7230099",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comprehensive Hemostasis and Thrombosis Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Peoria, IL
• Providers in Peoria, 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 Aug 8, 2008; 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.