NPIMap

Organization Active NPI

Uic College of Dentistry Oral Pathology Biopsy Service

  • Clinical Medical Laboratory
  • Chicago, IL
National Provider Identifier
1972755320
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
14D0646690 Issued in IL
Legal business name
UIC COLLEGE OF DENTISTRY ORAL PATHOLOGY BIOPSY SERVICE
Practice address
801 S Paulina St
Room 525a (M/C 838)
Chicago, IL 60612-7210
Phone
(312) 996-3633
Fax
(312) 996-9226
NPI assigned
Oct 16, 2008
Last updated
Oct 16, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Authorized official

Name
Sara C Gordon, DDS MSC FRCDCNPI 1871516088
Title
Director
Phone
(312) 996-1104

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 14D0646690 IL Primary

Addresses

Primary practice location

801 S Paulina St
Room 525a (M/C 838)
Chicago, IL 60612-7210

Mailing address

801 S Paulina St
Room 525a (M/C 838)
Chicago, IL 60612-7210
Phone (312) 996-3633

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0646690College of Dentistry, Dept Omfs801 S Paulina St, (MC-621, RM 110), Chicago, IL 60612Certificate of waiverMar 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
U of I Opthalmology Dep122 organizations share this tax ID, including this one
Part of
U of I Opthalmology Dep

Organizations with this tax ID in the same state 14

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

View all 14

Locations

801 S Paulina St
Rm 525A
Chicago, IL 60612
Phone (312) 996-3633

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1972755320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "address_2": "ROOM 525A (M/C 838)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210",
            "telephone_number": "312-996-3633",
            "fax_number": "312-996-9226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "address_2": "ROOM 525A (M/C 838)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210",
            "telephone_number": "312-996-3633",
            "fax_number": "312-996-9226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UIC COLLEGE OF DENTISTRY ORAL PATHOLOGY BIOPSY SERVICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "312-996-1104",
        "authorized_official_credential": "DDS MSC FRCDC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D0646690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.