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Organization
PREMIER PATHOLOGY SERVICES LLC
Active
Organization
PREMIER PATHOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOLPH D HAEGE MD (PRESIDENT)
(618) 234-2120
Entity
Organization
Contact information
Practice address
211 S 3RD ST, DEPT. OF PATHOLOGY, BELLEVILLE, IL 62220-1915
(618) 234-2120
(618) 222-4630
Mailing address
PO BOX 144333, ORLANDO, FL 32814-4333
(407) 422-9831
(407) 648-2065
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08232162
BCBS IL PIN
IL
01
—
241644
ADVANTRA PIN
IL
05
—
507261808
—
MO
01
—
717892
HEALTHLINK PIN
IL
01
—
DD7836
MEDICARE RAILROAD
IL
Enumeration date
10/13/2005
Last updated
07/21/2022
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