VINE STREET CLINICAL ASSOCIATES, LLC (NPI# 1356625966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356625966 |
| Entity Type | Organization |
| Organization Name | VINE STREET CLINICAL ASSOCIATES, LLC |
| Practice Address |
3225 Hedley Rd Springfield IL 62711-6248 |
| Mailing Address |
Po Box 3428 Springfield IL 62708-3428 |
| Practice Telephone | 2177267300 |
| Mailing Telephone | 8005775368 |
| Mailing Fax Number | 2177572021 |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-09-30 |
| Authorized Official Name | J TRAVIS DOWELL (VICE PRESIDENT MPS AND OPERATIONS) |
| Authorized Official Telephone | 2177883342 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 364SP0809X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Adult |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| Street Address |
3225 HEDLEY RD |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62711-6248 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447265145 | Rodica S Brisan | Psychiatry & Neurology | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2006-07-30 |
| 1356903637 | Carrie Mccormick | Registered Nurse | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2019-07-08 |
| 1467939140 | Constance A Habenschuss | Nurse Practitioner | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2018-07-25 |
| 1871070797 | Emily Jo Jennings | Nurse Practitioner | 3225 Hedley Rd, Springfield, IL 62711 | 2018-07-24 |
| 1396269700 | Amanda M Mavis | Nurse Practitioner | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2017-07-27 |
| 1265971741 | Denise Klemm | Social Worker | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2017-02-17 |
| 1285060004 | Jaime Louise Jensen-cole | Nurse Practitioner | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2013-09-25 |
| 1356645717 | Richard Schenkelberg | Psychiatry & Neurology | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2010-12-28 |
| 1265674162 | Kuldeep Singh | Psychiatry & Neurology | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2009-03-24 |
| 1689813206 | Patricia A Fehr | Counselor | 3225 Hedley Rd, Springfield, IL 62711-6248 | 2009-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578057220 | Merissa Pryor | Social Worker | 4200 Conestoga Drive, Mbn 120, Springfield, IL 62711 | 2018-06-17 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1841682424 | Americare At Centennial Pointe Assisted Living LLC | Assisted Living Facility | 3440 Hedley Road, Springfield, IL 62711 | 2015-02-19 |
| 1306249248 | Schon Dental, LLC | Dentist | 2809 Mansion Road Suite D, Springfield, IL 62711 | 2014-10-07 |
| 1891105490 | John Weiss | Pharmacist | 4200 Conestoga Drive, Springfield, IL 62711 | 2014-05-05 |
| 1720350689 | Victor Harold Lary | Family Medicine | 3251 Spaulding Orchard Road, Springfield, IL 62711 | 2012-02-07 |
| 1902181795 | Amanda Rose Davis | Pharmacist | 2500 Koke Mill Rd, Springfield, IL 62711 | 2011-10-12 |
| 1316233703 | Karen Zerkle | Dentist | 2809 Mansion Rd, Suite D, Springfield, IL 62711 | 2011-06-23 |
| 1255520557 | Link Chiropractic LLC | Chiropractor | 7012 Kingsmill Ct, Springfield, IL 62711 | 2007-10-23 |
| 1669688230 | Victoria Lynn Driskill | Dentist | 4701 W. Wabash Ave, Springfield, IL 62711 | 2007-05-14 |
| Find all providers in zip 62711 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164076683 | Forefront-khatkhate Medical Services PC | Psychiatry & Neurology | 600 S 2nd St Ste 404, Springfield, IL 62704-2542 | 2019-08-01 |
| 1699043976 | Terry Arthur Travis | Psychiatry & Neurology | 1200 Ravenswood, Na, Springfield, IL 62711-6079 | 2011-12-01 |
| 1659512184 | Julie A. Warren, Md LLC | Psychiatry & Neurology | 1911 S. National Avenue, Suite 405, Springfield, MO 65804 | 2009-03-12 |
| 1255577821 | William Basham | Psychiatry & Neurology | 5729 Main St # 330, Springfield, OR 97478-5426 | 2009-01-01 |
| 1679718043 | Leslie Jeanne Phelps | Psychiatry & Neurology | 1717 E. Primrose St., Apartment B204, Springfield, MO 65804-5413 | 2008-12-12 |
| 1134302656 | Interlink Behavioral Services, P.C. | Psychiatry & Neurology | 3121 S Terrace Green Ct, Springfield, MO 65804-4555 | 2007-12-06 |
| 1366621351 | Azra A Farooqui | Psychiatry & Neurology | 7745 Jewelweed Ct, Springfield, VA 22152-3148 | 2007-10-26 |
| 1093919714 | Lillian Joy Houston | Psychiatry & Neurology | 315 W Carpenter St Dept Of, Springfield, IL 62702-4901 | 2007-06-14 |
| 1881808145 | Yakhmi Mds | Psychiatry & Neurology | 1505 N Limestone St, Springfield, OH 45503-3317 | 2007-05-09 |
| 1588784706 | Asad Gobar | Psychiatry & Neurology | 5922 Hall St, Springfield, VA 22152-1401 | 2007-03-30 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62711 |
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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.