Doctor's Data, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D0646470 Issued in IL

Legal business name

DOCTOR'S DATA, INC.

Practice address

3755 Illinois Ave
St Charles, IL 60174-2420

Phone

(630) 377-8139

Fax

(630) 587-7860

NPI assigned

Nov 10, 2005

Last updated

Mar 30, 2015By 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

Darrell S Hickok

Title

Chief Executive Officer

Phone

(630) 377-8139

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1750362224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3755 ILLINOIS AVE",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742420",
            "telephone_number": "630-377-8139",
            "fax_number": "630-587-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3755 ILLINOIS AVE",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742420",
            "telephone_number": "630-377-8139",
            "fax_number": "630-587-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTOR'S DATA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-10",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "HICKOK",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "630-377-8139"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D0646470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in St Charles, IL
• Providers in St Charles, 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 Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.