Uic College of Dentistry Oral Pathology Biopsy Service
Organization Active NPI Clinical Medical Laboratory · Chicago, IL
NPI 1972755320 · NPPES record last updated Oct 16, 2008
Key facts
- NPI
- 1972755320
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 14D0646690 (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
- Organization subpart
- Yes
- Parent organization (as reported)
- UNIVERSITY OF ILLINOIS
Authorized official
- Name
- Sara C Gordon, DDS MSC FRCDC
- Title
- Director
- Phone
- (312) 996-1104
Corporate family (same tax ID) 14
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0646690 | College of Dentistry, Dept Omfs | Certificate of waiver | Mar 3, 2027 |
National Provider Directory
- Tax ID family
- Univ of Illinois Hospit
- Part of
- Univ of Illinois Hospit
Locations
801 S Paulina St
Rm 525A
Chicago, IL 60612
Phone (312) 996-3633
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 14D0646690 | IL | Yes |
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
Other providers in Chicago, IL
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- Uic Clinic
- Uic College of Dentistry
- Gerald Ujiki
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- Freda Ukeka
- Jenny Katherine Ukena
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All providers in Chicago, IL · Clinical Medical Laboratory in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.