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Forrest Family Practice Center LLC

Organization Active NPI Family Medicine Physician · Forrest, IL

NPI 1104003086 · NPPES record last updated Jul 2, 2009

Key facts

NPI
1104003086
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
FORREST FAMILY PRACTICE CENTER LLC
Practice address
122 E Wabash Ave
Forrest, IL 61741
Phone
(815) 657-8707
Fax
(815) 657-8717
NPI assigned
Jan 23, 2008
Organization subpart
Yes
Parent organization (as reported)
GIBSON COMMUNITY HOSPITAL ASSOCIATION

Authorized official

Name
Dr. Benjamin E Brewer, MD
Title
Owner
Phone
(815) 657-8707

Corporate family (same tax ID) 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

National Provider Directory

Tax ID family
The Paxton Clinic (42 organizations share this tax ID)
Part of
The Paxton Clinic

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

122 E Wabash Ave
Forrest, IL 61741

Mailing address

122 E Wabash Ave
P O Box 58
Forrest, IL 61741
Phone (815) 657-8707

Other identifiers

IdentifierTypeStateIssuer
364468162001MedicaidIL

Other names

  • Forrest Family Practice LLc Doing business as

Other providers in Forrest, IL

All providers in Forrest, IL · Family Medicine Physician in Illinois

Sources for this page

Verify at the official NPI Registry.