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General NPI Number Information
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NPI Number | 1568620409
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE FAMILY HEALTH CARE LAB
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15 FOUNDERS LN
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City | JACKSONVILLE
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State | IL
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Zip | 62650-3919
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Country | US
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Telephone | 217-291-1041
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 S 6TH ST
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City | SPRINGFIELD
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State | IL
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Zip | 62703-2403
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Country | US
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Telephone | 217-528-7541
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT & CFO
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Name | MR. ALAN NERONE
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Credential |
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Telephone | 217-528-7541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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