Gachugu Medical Clinic

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

GACHUGU MEDICAL CLINIC

Practice address

1 E Ferguson Ave
Wood River, IL 62095-1903

Phone

(618) 251-8138

Fax

(618) 251-8140

NPI assigned

Oct 16, 2020

Last updated

Oct 23, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Wilson Gachugu Ndungu, NP

Title

Authorized Official/Owner

Phone

(618) 917-9463

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1003414442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 E FERGUSON AVE",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951903",
            "telephone_number": "618-917-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E FERGUSON AVE",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951903",
            "telephone_number": "618-251-8138",
            "fax_number": "618-251-8140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GACHUGU MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-16",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "NDUNGU",
        "authorized_official_first_name": "WILSON",
        "authorized_official_middle_name": "GACHUGU",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/OWNER",
        "authorized_official_telephone_number": "618-917-9463",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Joseph Dirkers, M.D.
• East Alton Wood River HS Dist
• Kay Eberhart, M.M.P.
• First Step Counseling, Inc
• Foxes Grove SLP, LLC
• Crystal L Gedris, PHARMD
• Rachel Germann
• Jodi Lyn Gilmore, MS-CCC-SLP
• William M Goebel, DDS
• Frederic Golden, PHD

• Nurse Practitioner in Wood River, IL
• Providers in Wood River, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.