Georgetown Ridge Farm 4

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

Legal business name

GEORGETOWN RIDGE FARM 4

Practice address

400 W West St
Georgetown, IL 61846-1846

Phone

(217) 662-8488

Fax

(217) 662-3402

NPI assigned

Aug 25, 2006

Last updated

Aug 22, 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

Kevin Tate

Title

Superintendent

Phone

(217) 662-8488

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114035722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W WEST ST",
            "city": "GEORGETOWN",
            "state": "IL",
            "postal_code": "618461846",
            "telephone_number": "217-662-8488",
            "fax_number": "217-662-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W WEST ST",
            "city": "GEORGETOWN",
            "state": "IL",
            "postal_code": "618461846",
            "telephone_number": "217-662-8488",
            "fax_number": "217-662-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN RIDGE FARM 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "217-662-8488"
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Practice Medical Center LTD
• Marcy Fegett, R.N.
• Fusion of Wellness: Body, Mind, and Soul, LLC.
• Georgetown Fire Protection District Ambulance Service
• Laura E Melecosky-Zachman
• Kimberly Payne
• Sasha Pierce, LPN
• Isaiah Matthew Reeves, LPN
• Samantha Rieches

• Local Education Agency (LEA) in Georgetown, IL
• Providers in Georgetown, IL by specialty
• Local Education Agency (LEA) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.