Premier Pathology Services LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

PREMIER PATHOLOGY SERVICES LLC

Practice address

211 S 3Rd St
Dept. of Pathology
Belleville, IL 62220-1915

Phone

(618) 234-2120

Fax

(618) 222-4630

NPI assigned

Oct 13, 2005

Organization subpart

No

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

Authorized official

Name

Dolph D Haege, MD

Title

President

Phone

(618) 234-2120

Specialties & licenses 1

Addresses

Other identifiers 7

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306834346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 144333",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328144333",
            "telephone_number": "407-422-9831",
            "fax_number": "407-648-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S 3RD ST",
            "address_2": "DEPT. OF PATHOLOGY",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201915",
            "telephone_number": "618-234-2120",
            "fax_number": "618-222-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PATHOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HAEGE",
        "authorized_official_first_name": "DOLPH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-234-2120",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANTRA PIN",
            "identifier": "241644",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PIN",
            "identifier": "717892",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL PIN",
            "identifier": "08232162",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP PIN",
            "identifier": "241644",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DD7836",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507261808",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMR PIN",
            "identifier": "241644",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas E Poulos, MD
• Chloe Powell
• Veronica Powers
• Prairie Psychiatry, SC
• Premier Internal Medicine LLC
• Premise Health of Illinois Medical PC (St Claire - Belleville)
• Sarah Price, M.D.
• Susan Elizabeth Price, SSP, MAED
• Kosit Prieb, M.D.
• Prima Donna Salon

• Anatomic Pathology & Clinical Pathology Physician in Belleville, IL
• Providers in Belleville, IL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Illinois

• 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.