Organization
TAYLORVILLE MEDICAL ASSOCIATES LAB
Active
Parent organization
SPRINGFIELD CLINIC LLP
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPRINGFIELD CLINIC LLP
Authorized official
MR. RANDALL A BRYANT (CFO)
(217) 528-7541
Entity
Organization
Contact information
Practice address
303 E BIDWELL ST, TAYLORVILLE, IL 62568-1363
(217) 824-4939
Mailing address
303 E BIDWELL ST, TAYLORVILLE, IL 62568-1363
(217) 824-4939
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D0435310
CLIA
—
Enumeration date
05/28/2008
Last updated
08/01/2008
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