Provider Demographics
NPI:1376505495
Name:SCAN AMERICAN SPRINGFIELD LLC
Entity Type:Organization
Organization Name:SCAN AMERICAN SPRINGFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-599-7655
Mailing Address - Street 1:800 E CARPENTER ST
Mailing Address - Street 2:PO BOX 1977
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5324
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6021
Practice Address - Street 1:619 E MASON ST
Practice Address - Street 2:ROOM 4P70
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1034
Practice Address - Country:US
Practice Address - Phone:217-528-4633
Practice Address - Fax:217-528-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08432063OtherBLUE CROSS BLUE SHIELD
IL516545OtherHEALTHLINK
IL3333333OtherUMWA
ILP00052970OtherRAILROAD MEDICARE
IL081769OtherHEALTH ALLIANCE
IL3333333OtherUMWA