NPIMap

Organization Active NPI

Health Ventures of Southern Illinois LLC

Doing business as Tri-Lab LLC

  • Clinical Medical Laboratory
  • O'Fallon, IL
National Provider Identifier
1831179415
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
HEALTH VENTURES OF SOUTHERN ILLINOIS LLC
Doing business as
Tri-Lab LLC
Practice address
1512 N Green Mount Rd
Tri Lab LLC at St Elizabeths Medical Park
O Fallon, IL 62269-1953
Phone
(619) 624-3750
Fax
(618) 624-8478
NPI assigned
Jan 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Edward Hughes
Title
Executive Director
Phone
(618) 343-0639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1512 N Green Mount Rd
Tri Lab LLC at St Elizabeths Medical Park
O Fallon, IL 62269-1953

Mailing address

PO Box 790051
Saint Louis, MO 63179-0051
Phone (618) 343-0640

Other names 1

  • Tri-Lab LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Health Ventures of Southern Illinois LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831179415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790051",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631790051",
            "telephone_number": "618-343-0640",
            "fax_number": "618-343-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 N GREEN MOUNT RD",
            "address_2": "TRI LAB LLC AT ST ELIZABETHS MEDICAL PARK",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691953",
            "telephone_number": "619-624-3750",
            "fax_number": "618-624-8478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH VENTURES OF SOUTHERN ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-343-0639",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-Lab LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O'Fallon, IL

Sources for this page

  • 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.