Provider Demographics
NPI:1548363138
Name:PATHOLOGY ASSOCIATES OF CENTRAL ILLINOIS LTD
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF CENTRAL ILLINOIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ZHENQIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-788-3060
Mailing Address - Street 1:6450 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686
Mailing Address - Country:US
Mailing Address - Phone:217-788-3000
Mailing Address - Fax:217-788-5577
Practice Address - Street 1:701 N FIRST ST
Practice Address - Street 2:MEMORIAL MEDICAL CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781
Practice Address - Country:US
Practice Address - Phone:217-788-3000
Practice Address - Fax:217-788-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL325741Medicare ID - Type Unspecified