DR. JOHN THOMAS KELLY (NPI# 1164758892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164758892 |
| Entity Type | Individual |
| Full Name | DR. JOHN THOMAS KELLY |
| Credential | M.D. |
| Practice Address |
2105 Interlacken Dr Springfield IL 62704 |
| Mailing Address |
Po Box 13426 Springfield IL 62791-3426 |
| Practice Telephone | 2155274684 |
| Mailing Telephone | 2155274684 |
| Enumeration Date | 2009-10-31 |
| Last Update Date | 2018-06-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 036-077958 | IL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 900 Bryn Mawr Ave, Penn Valley, PA 190721404 | 2155274684 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902412893 | John Kelly | Home Health Aide | 337 Great Oaks Trl, Wadsworth, OH 44281-9427 | 2020-09-16 |
| 1952969826 | John Kelly | Community Health Worker | 4048 Crestwood Dr, Wausau, WI 54403-8122 | 2019-06-04 |
| 1629530712 | John J Kelly | Otolaryngology | 579 W Moorwood St, Green Valley, AZ 85614-5980 | 2019-04-05 |
| 1851886568 | John D Kelly | Counselor | 481 8th Ave Ste 520, New York, NY 10001-1809 | 2018-06-25 |
| 1255876041 | John Edward Kelly | Physician Assistant | 1340 Citizens Blvd, Leesburg, FL 34748-3924 | 2017-01-03 |
| 1225487986 | John Kelly | Pharmacist | 3761 Knollcroft St, Easton, PA 18045-3026 | 2016-06-03 |
| 1588023246 | John Kelly | Behavior Technician | 1118 Poindexter Ave W, Bremerton, WA 98312-4337 | 2016-02-23 |
| 1760880173 | John Kelly | Dentist | 4833 Bethesda Ave Ste 302, Bethesda, MD 20814-5244 | 2014-12-17 |
| 1508135252 | John Kelly | Counselor | 4550 Lantana Road, Suite A4, Lake Worth, FL 33463 | 2011-12-27 |
| 1497055008 | John Peter Kelly | Occupational Therapist | 21 Dorothy Ln, Kings Park, NY 11754-2932 | 2010-10-28 |
| Street Address |
2105 INTERLACKEN DR |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
| 1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
| 1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
| 1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
| 1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
| 1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
| Find all providers in zip 62704 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609218510 | Ojv Inc. | General Practice | 4936 Laverna Rd, Springfield, IL 62707-9797 | 2013-07-19 |
| 1861742223 | Victoria J. Dow | General Practice | 948 Clocktower Drive, Springfield, IL 62704 | 2012-09-13 |
| 1386963429 | Care Station Medical Group, Pa | General Practice | 90 Us Highway 22, Springfield, NJ 07081-3110 | 2010-05-28 |
| 1972747574 | Bradley Bradshaw | General Practice | 1904 S Shady Hill Ln, Springfield, MO 65809-2601 | 2009-04-27 |
| 1265685515 | International Medical Center, Inc | General Practice | 5410 Port Royal Rd, Suite 100, Springfield, VA 22151-2314 | 2008-10-30 |
| 1518121565 | Robert Charles Woods | General Practice | 1522 S Cedar Ridge St, Springfield, MO 65809-2356 | 2008-07-17 |
| 1083817639 | Saul Wider | General Practice | 359 Spring Valley Rd, Springfield, PA 19064 | 2007-06-08 |
| 1669681938 | Shwee-tian Chou | General Practice | 517 Boston Rd, Springfield, MA 01109-1230 | 2007-05-22 |
| 1326116229 | Abdulkareem I Kraidy | General Practice | 6801 Backlick Rd, Springfield, VA 22150-3071 | 2006-12-01 |
| 1821168683 | Doctors Hearing Center Pllc Xiig | General Practice | 1306 E Sunshine St, Springfield, MO 65804 | 2006-11-09 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62704 |
Please comment or provide details below to improve the information on DR. JOHN THOMAS KELLY.
| 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.