NPIMap

Health Ventures of Southern Illinois LLC

Organization Active NPI Clinical Medical Laboratory · O Fallon, IL

NPI 1831179415 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1831179415
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Medical Laboratory 291U00000X
Legal business name
HEALTH VENTURES OF SOUTHERN ILLINOIS 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
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 9

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

National Provider Directory

Tax ID family
Health Ventures of Southern Illinois LLC (10 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Yes

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

  • Tri-Lab LLC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "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

All providers in O Fallon, IL · Clinical Medical Laboratory in Illinois

Sources for this page

Verify at the official NPI Registry.