Independent US Healthcare Provider Directory & Public Medical Database
🏥
Deactivated NPI 1104268622 Deactivated / Inactive NPI

Pathsource Diagnostics, Llc

Pathology - Anatomic Pathology & Clinical Pathology • Silvis, IL

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Pathsource Diagnostics, Llc has officially deactivated this NPI record and ceased active healthcare operations.

Registration / Start Date July 25, 2013
NPI Deactivation Date April 05, 2021
Total Practice Duration ~8 Years of Practice (2013 – 2021)

About Pathsource Diagnostics, Llc NPI 1104268622 Summary

Pathsource Diagnostics, Llc was a registered healthcare organization specializing in Pathology - Anatomic Pathology & Clinical Pathology located in Silvis, IL. Operating from its primary practice location at 801 ILLINI DR, the facility provided medical services under NPI record 1104268622 prior to official deactivation on April 05, 2021.

Administrative records indicate Stanley Leung as the registered authorized official.

The facility is associated with 20 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

801 Illini Dr

Silvis, IL 612821804

Telephone 3092814812
Fax 3092814809

Authorized Official Information

Authorized Contact Name

Stanley Leung

Official Telephone

3092814812

Facility Classifications & Specialties

Pathology - Anatomic Pathology & Clinical Pathology Primary Taxonomy

NUCC Taxonomy Code: 207ZP0102X

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.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

20 Linked

Anesthesiology

Silvis, IL

View Practitioner Profile →

Nurse Practitioner - Family

Silvis, IL

View Practitioner Profile →

Anesthesiology

Silvis, IL

View Practitioner Profile →

Dietitian, Registered

Silvis, IL

View Practitioner Profile →
Dr. Heng Wu , MD NPI 1164721429

Anesthesiology

Silvis, IL

View Practitioner Profile →

Emergency Medicine

Silvis, IL

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

8 Historical Events
⚠️
NPI Profile Deactivated April 05, 2021

Record deactivated on April 05, 2021

⚠️
NPI Profile Deactivated April 04, 2021

Record deactivated on April 04, 2021

NPI Profile Active July 25, 2013

NPI status registered as active in NPPES database

📍
Updated Practice Location July 25, 2013

Registered at 801 ILLINI DR, SILVIS, IL 612821804 (Tel: 3092814812)

📍
Updated Business Mailing Address July 25, 2013

Registered at PO BOX 144333, ORLANDO, FL 328144333 (Tel: 4074229831)

🏛️
Organization / Clinic Name Updated July 25, 2013

Operating as PATHSOURCE DIAGNOSTICS, LLC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 25, 2013

Pathology

🟢
Initial NPI Registration & Enumeration July 25, 2013

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

0 Reviews
No reviews submitted yet for Pathsource Diagnostics, Llc. Be the first to share your experience with this healthcare facility!
Have you visited Pathsource Diagnostics, Llc? Sign in to your TRUE-MEDINFO account to submit a rating and review.
Sign In to Write a Review →

NPI Organization Metadata

NPI Number: 1104268622
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: July 25, 2013
Last Update: July 25, 2013
Deactivation Date: April 05, 2021

Mailing Address

Po Box 144333

Orlando, FL 328144333

Phone: 4074229831

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.