NPIMap

Organization Active NPI

Springfield Clinic Jacksonville Outreach Lab

  • Clinical Medical Laboratory
  • Jacksonville, IL
National Provider Identifier
1649409749
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB
Practice address
15 Founders LN
Jacksonville, IL 62650-3919
Phone
(217) 528-7541
NPI assigned
Jul 9, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SPRINGFIELD CLINIC, LLPAs reported in NPPES

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

15 Founders LN
Jacksonville, IL 62650-3919

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
14D1097569OtherCLIA

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1649409749",
    "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": "15 FOUNDERS LN",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503919",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPRINGFIELD CLINIC, LLP",
        "enumeration_date": "2009-07-09",
        "last_updated": "2022-07-21",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D1097569",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, 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.