Organization
SPRINGFIELD CLINIC PEDIATRIC CENTER LAB-2ND FLOOR
Active
Parent organization
SPRINGFIELD CLINIC, LLP
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPRINGFIELD CLINIC, LLP
Authorized official
MR. ALAN NERONE (SENIOR VICE PRESIDENT & CFO)
(217) 528-7541
Entity
Organization
Contact information
Practice address
2200 WABASH AVE, 2ND FLOOR, SPRINGFIELD, IL 62704-5352
(217) 528-7541
Mailing address
1025 SOUTH 6TH STREET, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D0664456
CLIA
—
Enumeration date
05/28/2008
Last updated
07/25/2017
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