Provider Demographics
NPI: | 1952552101 |
---|---|
Name: | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS |
Entity Type: | Organization |
Organization Name: | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS |
Other - Org Name: | UIMC REFERENCE LAB PROFESSIONAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT, CHIEF FINANCIAL OFF |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WALTER |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | KNORR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 312-996-8800 |
Mailing Address - Street 1: | 840 S WOOD ST |
Mailing Address - Street 2: | ROOM 170 (MC 750) |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60612-4325 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 312-355-5800 |
Mailing Address - Fax: | 312-996-8261 |
Practice Address - Street 1: | 840 S WOOD ST |
Practice Address - Street 2: | ROOM 170 (MC 750) |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60612-4325 |
Practice Address - Country: | US |
Practice Address - Phone: | 312-355-5800 |
Practice Address - Fax: | 312-996-8261 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2008-10-07 |
Last Update Date: | 2008-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Single Specialty |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Single Specialty |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Single Specialty |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Single Specialty |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | Group - Single Specialty |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Single Specialty |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | Group - Single Specialty |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | Group - Single Specialty |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | Group - Single Specialty |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | Group - Single Specialty |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Single Specialty |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Single Specialty |
No | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | Group - Single Specialty |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Single Specialty |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | Group - Single Specialty |