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NPI Code Detail

MEDICARE: SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB

MEDICARE: SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114D1097569OTHERCLIA

General Provider Information

NPI Number : 1649409749
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB
Provider Business Mailing Address
First Line : 1025 SOUTH 6TH STREET
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2403
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 15 FOUNDERS LN
Second Line :
City : JACKSONVILLE
State : IL
Zip : 62650-3919
Country : US
Telephone Number : 217-528-7541
Fax Number :
Authorized Official
Title or Position : SENIOR VICE PRESIDENT & CFO
Name : MR. ALAN NERONE
Credential :
Telephone Number : 217-528-7541
Provider Enumeration Date : 07/09/2009
Last Update Date : 07/21/2022

Similar Medicare Providers

1568184976 — CARA MARIE CRAIN FNP-C
Practice Location Address:
15 FOUNDERS LN
JACKSONVILLE, IL
62650-3919
Practice Phone: 217-291-1041
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1568620409 — JACKSONVILLE FAMILY HEALTH CARE LAB
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1144455767 — ABIGAIL S WHITE MD
Practice Location Address:
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62650-3919
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Practice Fax:
1598068793 — SPRINGFIELD CLINIC LLP
Practice Location Address:
15 FOUNDERS LN
JACKSONVILLE, IL
62650-3919
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Practice Fax:
1558614867 — MEMORIAL PHYSICIAN SERVICES
Practice Location Address:
15 FOUNDERS LN , SUITE 100
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Practice Fax: 217-245-6775

Directions to “SPRINGFIELD CLINIC JACKSONVILLE OUTREACH LAB ” Practice Location

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