DR. GLEN J SIDLER (NPI# 1043298557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043298557 |
| Entity Type | Individual |
| Full Name | DR. GLEN J SIDLER |
| Credential | M.D. |
| Practice Address |
201 N Cummings Ln Washington IL 61571-2181 |
| Mailing Address |
201 N Cummings Ln P.o. Box 310 Washington IL 61571-2181 |
| Practice Telephone | 3094442005 |
| Practice Fax Number | 3094442006 |
| Mailing Telephone | 3094442005 |
| Mailing Fax Number | 3094442006 |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2014-10-29 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 036060332 | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036060332 | 05 | |
| IL | NPI | 1043298557 | 01 |
| Street Address |
201 N CUMMINGS LN |
| City | WASHINGTON |
| State | IL |
| Zip Code | 61571-2181 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952811259 | Stacey Herring | Nurse Practitioner | 201 N Cummings Ln, Washington, IL 61571-2181 | 2017-10-02 |
| 1972989838 | Danielle Pray | Nurse Practitioner | 201 N Cummings Ln, Washington, IL 61571-2181 | 2015-08-03 |
| 1285727248 | David E. Dillon | Psychologist | 201 N Cummings Ln, Washington, IL 61571-2181 | 2006-10-02 |
| 1104830520 | Illini Family Medicine | Family Medicine | 201 N Cummings Ln, Washington, IL 61571-2181 | 2006-07-28 |
| 1518994144 | Gerilyn Ahrens | Physician Assistant | 201 N Cummings Ln, Washington, IL 61571-2181 | 2006-06-27 |
| 1417983487 | Lee T Kinsinger | Family Medicine | 201 N Cummings Ln, Washington, IL 61571-2181 | 2006-06-23 |
| 1598791527 | Jill E Schertz | Physician Assistant | 201 N Cummings Ln, Washington, IL 61571-2181 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904504 | Kelly Hornberger | Physical Therapist | 1201 Newcastle Rd., Washington, IL 61571 | 2018-09-01 |
| 1073050407 | Jillyn Cross | Occupational Therapist | 14 Oxford Court, Washington, IL 61571 | 2017-01-24 |
| 1639410772 | Stephen L Dejaynes | Counselor | 100 Hillcrest Drive, Washington, IL 61571 | 2013-03-14 |
| 1184998692 | One Counseling and Wellness | Counselor | 1003 North Cummings Lane, Washington, IL 61571 | 2012-03-01 |
| 1871878371 | M Lisa Kim | Pharmacist | 1700 Saddleridge Ct, Washington, IL 61571 | 2011-10-15 |
| 1073805156 | Skill Sprout International | Behavioral Analyst | 102 Walnut Street, Washington, IL 61571 | 2011-05-09 |
| 1659600948 | Skill Sprout, LLC | Behavioral Analyst | 128 Washington Square, Washington, IL 61571 | 2009-12-15 |
| 1700024916 | Julie Adams | Developmental Therapist | 700 S. Elm, Washington, IL 61571 | 2009-01-26 |
| 1851595128 | Michael John Herman | Dentist | 106 So Cummings Lane, Washington, IL 61571 | 2007-06-12 |
| 1861539132 | Gary Lee Cunningham | Dentist | 5 Laurel Ct., Washington, IL 61571 | 2007-01-30 |
| Find all providers in zip 61571 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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|---|---|---|---|---|
| 1356859334 | Providence Health Services, Inc | Specialist | 1150 Varnum St Ne Ste 300, Washington, DC 20017-2180 | 2018-01-12 |
| 1144761016 | Elisabeth Payne | Specialist | 1334 Rittenhouse St Nw, Washington, DC 20011-1106 | 2017-03-13 |
| 1821532649 | Dr. Richard Smilie, Veterinarian | Specialist | 1622 32nd St Nw, Washington, DC 20007-2930 | 2016-12-13 |
| 1871947812 | Olusola Zaccheus | Specialist | 269 56th St Ne, Washington, DC 20019-6744 | 2016-04-15 |
| 1215390331 | Jessica Lynn Fornieri | Specialist | 3700 O St Nw, Washington, DC 20057-0002 | 2016-04-05 |
| 1497115083 | Kathleen Pyne | Specialist | 1728 Willard St Nw, Washington, DC 20009-1719 | 2016-02-25 |
| 1932568276 | Trusted Urology Inc | Specialist | 1140 Varnum St Ne Ste 208a, Washington, DC 20017-2153 | 2016-02-15 |
| 1841663135 | Leonard Mcpherson | Specialist | 4705 Asbury Pl. N.w., Washington, DC 20016 | 2015-11-09 |
| 1396118782 | Dante Settles | Specialist | 3564 Fort Lincoln Dr Ne, Washington, DC 20018-4312 | 2015-11-05 |
| 1487023479 | Maria Jevon Fortune | Specialist | 5057 Astor Pl Se Apt 203, Washington, DC 20019-7683 | 2015-09-19 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 61571 |
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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.