MERCY CLINIC ILLINOIS, LLC (NPI# 1164089124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164089124 |
| Entity Type | Organization |
| Organization Name | MERCY CLINIC ILLINOIS, LLC |
| Practice Address |
1019 Valmeyer Rd Columbia IL 62236-4123 |
| Practice Telephone | 3145435244 |
| Practice Fax Number | 3145435248 |
| Mailing Telephone | 3145435244 |
| Mailing Fax Number | 3145435248 |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2019-05-24 |
| Authorized Official Name | CHERYL L MATEJKA (CFO) |
| Authorized Official Telephone | 3142511958 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
1019 VALMEYER RD |
| City | COLUMBIA |
| State | IL |
| Zip Code | 62236-4123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962937300 | Assoicated Physicians Group Ltd | Nurse Practitioner | 1011 South, Suite 3b, Columbia, IL 62236 | 2017-04-24 |
| 1316284854 | Robert Siekerka | Pharmacist | 1412 N Evergreen Ln, Columbia, IL 62236 | 2013-01-03 |
| 1972874352 | Jennifer Harlin Wilhelm | Veterinarian | 1400 Columbia Center Drive, Bellson Animal Hospital, Columbia, IL 62236 | 2012-01-18 |
| 1912275314 | Synergy Therapeutics, PC | Dentist | 1000 Eleven South, Suite 3f, Columbia, IL 62236 | 2011-12-13 |
| 1134455991 | Julie Williams | Skilled Nursing Facility | 3 Eagle Crest Court, Columbia, IL 62236 | 2009-10-28 |
| 1831311158 | Lifetime Dental Care of Illinois, PC | Dentist | 240 Southwoods Centre Drive, Columbia, IL 62236 | 2007-05-03 |
| 1730301268 | Affordable Dentistry Today, PC | Dentist | 242 Southwoods Centre Drive, Columbia, IL 62236 | 2007-05-03 |
| 1710109616 | Jason Clay King | Chiropractor | 117 West Cedar Street, Columbia, IL 62236 | 2007-05-02 |
| 1184704900 | Mitan Pediatric Therapy Inc | Occupational Therapist | 891 Meadowview Lane, Columbia, IL 62236 | 2006-10-16 |
| 1265528368 | Kathryn Ann Mager | Counselor | 9273 Coach Stop Road, Columbia, IL 62236 | 2006-10-05 |
| Find all providers in zip 62236 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808815 | Thai Quoc Nguyen | Internal Medicine | University Hospital Ma421 Med Sciences Bldg, Columbia, MO 65212-0001 | 2020-07-06 |
| 1649898784 | Peter Egwom | Internal Medicine | University Hospital One Hospital Drive Dc.043.00, Columbia, MO 65212-0001 | 2020-07-06 |
| 1790302362 | Klariz Teves Tucker | Internal Medicine | Internal Medcine Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-30 |
| 1851918346 | Maxwell Isaac | Internal Medicine | University Hospital 1 Hospital Drive Dc 043.00, Columbia, MO 65212-0001 | 2020-06-30 |
| 1285251983 | Shannon Ejiofor | Internal Medicine | University Hospital One Hospital Drive Dc043.00, Columbia, MO 65212-0001 | 2020-06-29 |
| 1336766278 | Jordan Stauffer | Internal Medicine | University Hospital One Hospital Dr, Columbia, MO 65212-0001 | 2020-06-26 |
| 1972120814 | Pak Ho Au | Internal Medicine | University Hospital One Hospital Dr Dc043.00, Columbia, MO 65212-0001 | 2020-06-26 |
| 1700402849 | Michael Allan Goble | Internal Medicine | Internal Medical Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-24 |
| 1740806389 | Alan Verl Godfrey | Internal Medicine | University of Missouri Hospital 1 Hospital Dr, Columbia, MO 65212-0001 | 2020-06-19 |
| 1003432642 | Gregory Gaskey | Internal Medicine | University of Missouri Hospital One Hospital Drive, Columbia, MO 65212-0001 | 2020-06-19 |
| Find all providers in COLUMBIA | ||||
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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.