Active NPI
Infinite Medical Center LLC
- Family Medicine Physician
- Glen Carbon, IL
National Provider Identifier
1013470905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- INFINITE MEDICAL CENTER LLC
- Practice address
- 220 Evergreen Drive
Glen Carbon, IL 62034-6203 - Phone
- (618) 655-0333
- NPI assigned
- Apr 9, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ryan Cleland, DC
- Title
- Owner
- Phone
- (618) 980-3150
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
220 Evergreen Drive
Glen Carbon, IL 62034-6203
Mailing address
28 Meadow Rue Dr
Edwardsville, IL 62025-3141
Phone (618) 980-3150
National Provider Directory
National Provider DirectoryLocations
220 Evergreen Ln
Glen Carbon, IL 62034
Phone (309) 212-5663
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554768000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1560211200000",
"number": "1013470905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 MEADOW RUE DR",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620253141",
"telephone_number": "618-980-3150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 EVERGREEN DRIVE",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620346203",
"telephone_number": "618-655-0333"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INFINITE MEDICAL CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-04-09",
"last_updated": "2019-06-11",
"status": "A",
"authorized_official_last_name": "CLELAND",
"authorized_official_first_name": "RYAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "618-980-3150",
"authorized_official_credential": "DC"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Glen Carbon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.