CLARK OLAVI ANDELIN (NPI# 1013114453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013114453 |
| Entity Type | Individual |
| Full Name | CLARK OLAVI ANDELIN |
| Credential | MD |
| Practice Address |
927 Broadway St Quincy IL 62301-2719 |
| Mailing Address |
1005 Broadway St Quincy IL 62301-2834 |
| Practice Telephone | 2172238400 |
| Practice Fax Number | 2172239172 |
| Mailing Telephone | 2172238400 |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-10-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 036148618 | IL | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 2007019019 | MO | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043538705 | Clark D Andelin | Dentist | 3400 Spruce St, Philadelphia, PA 19104-4206 | 2010-05-05 |
| Street Address |
927 BROADWAY ST |
| City | QUINCY |
| State | IL |
| Zip Code | 62301-2719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164429957 | Venu Reddy | Internal Medicine | 927 Broadway St, Suite 204, Quincy, IL 62301-2719 | 2005-07-07 |
| 1932716925 | Olivia Louise Patterson | Registered Nurse | 927 Broadway St, Quincy, IL 62301-2719 | 2020-09-24 |
| 1598375727 | Marissa Jo Lumpkin | Behavior Technician | 927 Broadway St, Quincy, IL 62301-2719 | 2020-08-03 |
| 1093347429 | Mandi Nicole Law | Nurse Practitioner | 927 Broadway St, Quincy, IL 62301-2719 | 2020-02-04 |
| 1720618457 | Laura Starman | Nurse Practitioner | 927 Broadway St, Quincy, IL 62301-2719 | 2020-01-22 |
| 1033761234 | Ashley Monita Smith | Social Worker | 927 Broadway St, Quincy, IL 62301-2719 | 2019-07-09 |
| 1659834273 | Debra Anna Derhake | Health Educator | 927 Broadway St, Quincy, IL 62301-2719 | 2019-04-10 |
| 1881157493 | Erin Katharine Vonderhaar | Health Educator | 927 Broadway St, Quincy, IL 62301-2719 | 2019-04-10 |
| 1598228116 | Aleshia Dawn Gerding | Health Educator | 927 Broadway St, Quincy, IL 62301-2719 | 2019-04-10 |
| 1992268510 | Dawn Crabtree | Health Educator | 927 Broadway St, Quincy, IL 62301-2719 | 2019-04-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356969471 | Lutheran Child and Family Service of Illinois | Foster Care Agency | 1400 N. 30th St, Quincy, IL 62301 | 2020-07-07 |
| 1134749716 | Bethany Nicole Jumps | Pharmacist | Broadway St & N 11th St, Quincy, IL 62301 | 2020-04-23 |
| 1043844293 | S.crider Construction An Supply Corp. | Contractor | 529 Woodbridge Dr., Quincy, IL 62301 | 2020-02-26 |
| 1245862002 | Quincy Physicians & Surgeons Clinic, Sc | Clinic/Center | 3301 Broadway St., Quincy, IL 62301 | 2020-02-10 |
| 1043851488 | West Central Illinois Nutrition | In Home Supportive Care | 639 York St. Room 333, Quincy, IL 62301 | 2019-10-07 |
| 1861986549 | Quincy Physicians & Surgeons Clinic, Sc | Internal Medicine | 3347 Broadway St, Quincy, IL 62301 | 2018-06-18 |
| 1194255083 | Michael Andrew Behrens | Nurse Practitioner | Broadway and 11th Street, Quincy, IL 62301 | 2017-06-14 |
| 1770987323 | Kirsty Yvonne Reed | Counselor | 205 S. 24th Street, Chaddock, Quincy, IL 62301 | 2014-10-10 |
| 1114234499 | Dale D. Shahan Dds Ltd | Dentist | 636 Hampshire Suite 102, Quincy, IL 62301 | 2010-09-08 |
| 1730314071 | James D Kaufmann | Pharmacist | 14th & Broadway, Quincy, IL 62301 | 2009-05-15 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| 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 Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437348638 | Richard S Underkofler | Obstetrics & Gynecology | 1600 Crown Colony Drive, Harvard Pilgrim Healthcare, Quincy, MA 02169 | 2007-10-24 |
| 1407914708 | Christine Curley Skiadas | Obstetrics & Gynecology | 1250 Hancock Street, Harvard Vanguard Medical Associates, Quincy, MA 02169 | 2006-12-05 |
| 1396810891 | Robin A Fischer | Obstetrics & Gynecology | Bcbs of Ma, One Enterprise Drive, Quincy, MA 02171 | 2006-11-21 |
| 1619902202 | Jill Kristine Satorie | Obstetrics & Gynecology | 300 Congress St Ste 102, Quincy, MA 02169-0907 | 2006-07-11 |
| 1790135556 | Jennie Krasker | Obstetrics & Gynecology | 1250 Hancock St, Quincy, MA 02169-4339 | 2016-06-13 |
| 1356751366 | Katy Marie Wand | Obstetrics & Gynecology | 1118 Hampshire St, Quincy, IL 62301-3027 | 2014-04-29 |
| 1811333420 | Sarah Marie Fryc | Obstetrics & Gynecology | 300 Congress St Ste 102, Quincy, MA 02169-0907 | 2013-05-22 |
| 1487924239 | Crown Obstetrics and Gynecology | Obstetrics & Gynecology | 300 Congress St, Suite 102, Quincy, MA 02169-0907 | 2012-01-11 |
| 1467741355 | Jessica Whitney Curry | Obstetrics & Gynecology | 927 Broadway St, Quincy, IL 62301-2719 | 2011-03-31 |
| 1215179155 | Obioma Nnene Maduakor | Obstetrics & Gynecology | 1118 Hampshire St, Quincy, IL 62301-3027 | 2009-03-24 |
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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.