MEMORIAL PHYSICIAN SERVICES (NPI# 1104179415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104179415 |
| Entity Type | Organization |
| Organization Name | MEMORIAL PHYSICIAN SERVICES |
| Practice Address |
1602 W Lafayette Ave Jacksonville IL 62650-1007 |
| Mailing Address |
Po Box 3428 Springfield IL 62708-3428 |
| Practice Telephone | 2172437200 |
| Practice Fax Number | 2172436165 |
| Mailing Telephone | 8005775368 |
| Mailing Fax Number | 2177572021 |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2012-10-26 |
| Authorized Official Name | JAMES T DOWELL (VICE PRESIDENT, MPS) |
| Authorized Official Telephone | 2177883342 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RHC MEDICARE PTAN | 148906 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316470651 | Memorial Physician Services | Internal Medicine | 701 N 1st St, Mailbox 95, Springfield, IL 62781-0001 | 2017-04-04 |
| 1275065906 | Memorial Physician Services | Internal Medicine | 701 N 1st St, Mailbox 95, Springfield, IL 62781-0001 | 2017-03-31 |
| 1063961936 | Memorial Physician Services | General Acute Care Hospital | 3132 Old Jacksonville Rd, Springfield, IL 62704-7400 | 2016-10-03 |
| 1205180056 | Memorial Physician Services | Clinic/Center | 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650-1136 | 2012-11-01 |
| 1174877930 | Memorial Physician Services | Nurse Practitioner | 3132 Old Jacksonville Rd, Springfield, IL 62704-7400 | 2012-11-01 |
| 1558614867 | Memorial Physician Services | Clinic/Center | 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 | 2012-10-24 |
| 1881947174 | Memorial Physician Services | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2012-10-24 |
| 1790038099 | Memorial Physician Services | Clinic/Center | 1 Centre Dr, Petersburg, IL 62675-9467 | 2012-10-24 |
| 1568715126 | Memorial Physician Services | Clinic/Center | 515 N College St, Lincoln, IL 62656-1401 | 2012-10-19 |
| 1477614105 | Memorial Physician Services | Clinic/Center | 515 N College St, Lincoln, IL 62656-1401 | 2006-12-13 |
| Street Address |
1602 W LAFAYETTE AVE |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295733830 | James Anthony Bohan | Family Medicine | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2005-07-08 |
| 1528299955 | Abby L Cunningham | Nurse Practitioner | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2009-08-03 |
| 1619129897 | Jacksonville, LLC | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2008-10-21 |
| 1740431345 | Jacksonville, LLC | Internal Medicine | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2008-10-02 |
| 1124181482 | Healthcare Network Associates | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2006-12-18 |
| 1568471464 | Healthcare Network Associates of Sangamon | Family Medicine | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2006-08-07 |
| 1932174133 | Jennifer G Flinn | Nurse Practitioner | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2006-02-21 |
| 1902892037 | James Edward Hinchen | Family Medicine | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2005-09-23 |
| 1245226372 | Marshall T Hale | Family Medicine | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2005-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053804443 | Siu Physicians & Surgeons, Inc | Clinic/Center | 610 N Westgate Ave, Jacksonville, IL 62650-1152 | 2018-06-11 |
| 1861991226 | Jacksonville Hospital LLC | Clinic/Center | 203 Nacogdoches St Ste 280, Jacksonville, TX 75766-2444 | 2018-02-12 |
| 1922410836 | Passavant Physician Association | Clinic/Center | 557 N Westgate Ave, Jacksonville, IL 62650-1156 | 2014-05-27 |
| 1205180056 | Memorial Physician Services | Clinic/Center | 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650-1136 | 2012-11-01 |
| 1558614867 | Memorial Physician Services | Clinic/Center | 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 | 2012-10-24 |
| 1881947174 | Memorial Physician Services | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2012-10-24 |
| 1821366170 | East Texas Medical Center Jacksonville | Clinic/Center | 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2444 | 2011-12-01 |
| 1598068793 | Springfield Clinic LLP | Clinic/Center | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2010-12-09 |
| 1619129897 | Jacksonville, LLC | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2008-10-21 |
| 1437301611 | Jacksonville, LLC | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2008-10-21 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on MEMORIAL PHYSICIAN SERVICES.
| 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.