Healthcare Provider Details

I. General information

NPI: 1962495119
Provider Name (Legal Business Name): LIPID ANALYSIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N 7TH ST
SPRINGFIELD IL
62701-1014
US

IV. Provider business mailing address

326 N 7TH ST
SPRINGFIELD IL
62701-1014
US

V. Phone/Fax

Practice location:
  • Phone: 217-535-3878
  • Fax: 217-522-1206
Mailing address:
  • Phone: 217-535-3878
  • Fax: 217-522-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateIL

VIII. Authorized Official

Name: CYNTHIA DEITRICK
Title or Position: DIRECTOR
Credential: MS
Phone: 217-535-3878