PRAIRIE PATHOLOGY AND LABORATORY PHYSICIANS (NPI# 1265433312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265433312 |
| Entity Type | Organization |
| Organization Name | PRAIRIE PATHOLOGY AND LABORATORY PHYSICIANS |
| Practice Address |
Virginia At Franklin Bromenn Regional Medical Center Normal IL 61761 |
| Mailing Address |
Po Box 1808 Bloomington IL 61702-1808 |
| Practice Telephone | 3094540731 |
| Practice Fax Number | 3094522375 |
| Mailing Telephone | 3094540731 |
| Mailing Fax Number | 3094522375 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | YOUNG BAI KIM (DIRECTOR) |
| Authorized Official Telephone | 3094540731 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
========= | IL | Allopathic & Osteopathic Physicians |
| Street Address |
VIRGINIA AT FRANKLIN BROMENN REGIONAL MEDICAL CENTER |
| City | NORMAL |
| State | IL |
| Zip Code | 61761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681796 | Brittany Nicole Mekley | Nurse Practitioner | 201 N. University, Normal, IL 61761 | 2020-08-28 |
| 1679108971 | Krystal Halliday | Occupational Therapist | 1815 N Towanda Barnes Rd, Normal, IL 61761 | 2020-03-06 |
| 1265915474 | Laine E Burek | Nurse Practitioner | 1765 Bradford Ln., Normal, IL 61761 | 2018-09-13 |
| 1801389986 | Ashley Michelle James | Specialist/Technologist | 347 S. University St, Normal, IL 61761 | 2018-06-12 |
| 1447750708 | Shelley R. Ruch | Specialist/Technologist, Other | 1604 Visa Drive, Ste 1, Normal, IL 61761 | 2018-02-13 |
| 1497275069 | Mclean County Nursing Home | Non-emergency Medical Transport (VAN) | 901 N. Main St, Normal, IL 61761 | 2017-06-23 |
| 1235673666 | Megan Threm | Registered Nurse | 900 Franklin Ave Community Health Care Clinic, Normal, IL 61761 | 2016-12-04 |
| 1437513553 | Tiesha Smith | Specialist | 1800 Rockingham Dr, Apt 1d, Normal, IL 61761 | 2016-04-06 |
| 1285031658 | New Day Recovery | Community/Behavioral Health | 402 Summit, Normal, IL 61761 | 2014-12-01 |
| 1174927701 | Alyssa Marie Bruck | Occupational Therapist | 700 N Walnut St, Normal, IL 61761 | 2014-10-10 |
| Find all providers in zip 61761 | ||||
| Taxonomy Code | 207ZP0105X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Clinical Pathology/Laboratory Medicine |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pathology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1437272549 | Robert E. Merrick | Pathology | 1633 W Berwyn Ave, Chicago, IL 60640-2005 | 2007-04-06 |
| 1740201003 | Apl Clinical Pathology | Pathology | 800 E Carpenter, Springfield, IL 62769-0001 | 2006-07-22 |
| 1235163056 | Renuka Bhaskar | Pathology | 105 Krispy Kreme Dr, Ste 4, Bloomington, IL 61704-3751 | 2006-07-10 |
| 1881625341 | Winfield Laboratory Consultants, S.c. | Pathology | 25 Winfield Rd, Winfield, IL 60190 | 2006-07-05 |
| 1790747517 | Anjen Chenn | Pathology | 303 E Chicago Ave, Ward 3-200, Chicago, IL 60611-4296 | 2006-04-05 |
| 1720063217 | Roy M.y. Nomura | Pathology | 1270 Mercantile Dr, Highland, IL 62249-1256 | 2005-12-07 |
| 1801880976 | William K Drake | Pathology | 400 Caldwell, Staunton, IL 62088-1173 | 2005-09-06 |
| 1598111403 | Kyle G Parker | Pathology | 5841 S Maryland Ave # Mc3083, Chicago, IL 60637-1447 | 2016-05-10 |
| 1538515473 | Samuel E Weinberg | Pathology | 251 E Huron St, Chicago, IL 60611-3055 | 2016-05-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.