TEN BROECK TENNESSEE PHYSICIANS GROUP INC (NPI# 1275155418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275155418 |
| Entity Type | Organization |
| Organization Name | TEN BROECK TENNESSEE PHYSICIANS GROUP INC |
| Practice Address |
45oo Memorial Drive Belleville IL 62226-5399 |
| Mailing Address |
1 Medical Center Blvd Cookeville TN 38501-4294 |
| Practice Telephone | 6182575900 |
| Practice Fax Number | 6182575463 |
| Mailing Telephone | 9317832511 |
| Mailing Fax Number | 9317832550 |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |
| Authorized Official Name | GLENDA F GUY (DIRECTOR, COMPLIANCE) |
| Authorized Official Telephone | 9317832511 |
| Is Organization Subpart | Y |
| Parent Organization Name | TEN BROECK TENNESSEE PHYSICIANS GROUP INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Memorial Senior Counseling Services | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 802 N 8th St, Vandalia, IL 624711756 | 6182831731 | 6182830590 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083236012 | Ten Broeck Tennessee Physicians Group Inc | Clinic/Center | 802 N 8th St, Vandalia, IL 62471-1756 | 2020-05-13 |
| 1639599582 | Ten Broeck Tennessee Physicians Group Inc | Psychiatry & Neurology | 1 Medical Center Blvd, Cookeville, TN 38501-4294 | 2014-04-18 |
| Street Address |
45OO MEMORIAL DRIVE |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62226-5399 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1053969790 | Consistent Medical Transportation | Driver | 2012 N 17th St, Swansea, IL 62226 | 2019-08-27 |
| 1497314371 | Medi-plex Hospice of Illinois, LLC | Registered Nurse | 8 Park Place, Suite #3, Swansea, IL 62226 | 2019-06-13 |
| 1336617364 | Nicole Renee Schmidt | Speech-Language Pathologist | 150 N 27th St., Belleville, IL 62226 | 2018-11-07 |
| 1295258903 | Catherine Espino | Pharmacist | 11 Chambers Blvd, Swansea, IL 62226 | 2017-07-25 |
| 1366806838 | Kiley Faires | Nurse Practitioner | 4600 Memorial Drive Ste 360, Belleville, IL 62226 | 2016-04-11 |
| 1760857585 | Mvp Transportation | Non-emergency Medical Transport (VAN) | 1229 N 17th Street, Number 23, Belleville, IL 62226 | 2015-12-04 |
| 1275952566 | Aisha Danyale Franklin | Internal Medicine | 4261 Woodfield Pl, Belleville, IL 62226 | 2014-04-15 |
| 1396168332 | Jayne E. Ninness | Physical Therapy Assistant | 4500 Memorial Dr., Memorial Hospital, Belleville, IL 62226 | 2014-01-28 |
| 1053758193 | Gateway Foundation, Inc. | Clinic/Center | 1 Bronze Point, Suite 1, Swansea, IL 62226 | 2013-05-30 |
| Find all providers in zip 62226 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245831569 | Chicago Psychiatric LLC | Clinic/Center | 800 W Cornelia Ave Apt 303, Chicago, IL 60657-2086 | 2020-11-03 |
| 1184223133 | Kevin P. Mcdunn, Psyd, LLC | Clinic/Center | 605 W Madison St Apt 2001, Chicago, IL 60661-2469 | 2020-10-21 |
| 1699372250 | Ctf Illinois | Clinic/Center | 1400 Reynolds Dr, Charleston, IL 61920-2411 | 2020-10-07 |
| 1124634852 | Prosper Counseling Services | Clinic/Center | 808 W Junior Ter Apt 303, Chicago, IL 60613-1657 | 2020-09-17 |
| 1962017665 | Hopeology, Pllc | Clinic/Center | 700 E North St Ste B, Elburn, IL 60119-7009 | 2020-09-10 |
| 1013521301 | Self Connected Therapy LLC | Clinic/Center | 2189 N. Rt. 83, #292, Round Lake Beach, IL 60073 | 2020-09-03 |
| 1508479288 | Bash Psychotherapy Corporation | Clinic/Center | 413 E Berry Rd, Barrington, IL 60010-3317 | 2020-08-24 |
| 1326658402 | Ventura Counseling, LLC | Clinic/Center | 620 Manchester Ave, Westchester, IL 60154-2714 | 2020-08-04 |
| 1265040760 | Orchid Counseling Chicago | Clinic/Center | 451 W Melrose St Apt 610, Chicago, IL 60657-3826 | 2020-07-21 |
| 1164040630 | Sunshine Therapy Pllc | Clinic/Center | 3328 N Bell Ave, Chicago, IL 60618-6204 | 2020-07-10 |
| Find all providers with the same taxonomy | ||||
| City | BELLEVILLE |
| Zip Code | 62226 |
Please comment or provide details below to improve the information on TEN BROECK TENNESSEE PHYSICIANS GROUP INC.
| 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.