Medical Diagnostic Laboratory, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MEDICAL DIAGNOSTIC LABORATORY, INC

Practice address

45 Sheffield Dr
Belleville, IL 62223-3557

Phone

(618) 233-0522

NPI assigned

Jul 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Pongpitoon, MT(ASCP) M.P.H.

Title

President

Phone

(618) 233-0522

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vidya Deshpande, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Belleville, IL
  • NPI 1255316725
  NPD (past)
• Neil L Jorgensen, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Scott AFB, IL
  • NPI 1467449454
  NPD (past)
• Paul R. Gierl, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Kennewick, WA
  • NPI 1679847370
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699706770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 SHEFFIELD DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622233557",
            "telephone_number": "618-233-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 SHEFFIELD DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622233557",
            "telephone_number": "618-233-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PONGPITOON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-233-0522",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MT(ASCP) M.P.H."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "110795",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "3509010",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MISSOURI",
            "identifier": "31251",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "50000463",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "32714",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather McIntyre
• Justin Leigh McKevitt, MSW, LCSW
• Susan Kay McLaughlin, OT
• Molly Beth McVey, LCSW
• Robert W Mecker Jr., M.D.
• Medicine Express, LLC (Medicine Express)
• Judith Ann Meek, CPNP
• Gail Ann Meese, D.C.
• Kenneth Arthur Meierotto, D.O.
• Robert L Meinders, DC

• Clinical Medical Laboratory in Belleville, IL
• Providers in Belleville, 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 22, 2020; 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.