Provider Demographics
NPI:1235633777
Name:SPRINGFIELD CLINIC LLP
Entity Type:Organization
Organization Name:SPRINGFIELD CLINIC LLP
Other - Org Name:SPRINGFIELD CLINIC MOWEAQUA LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NERONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-7541
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:620 N PUTNAM ST
Practice Address - Street 2:
Practice Address - City:MOWEAQUA
Practice Address - State:IL
Practice Address - Zip Code:62550-9482
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGFIELD CLINIC LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory