Backroad Health Care Inc
Organization Active NPI Family Nurse Practitioner · Centralia, IL
NPI 1134582018 · NPPES record last updated Mar 18, 2019
Key facts
- NPI
- 1134582018
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- BACKROAD HEALTH CARE INC
- Practice address
- 211 S Perrine Ave
Centralia, IL 62801-3635 - Phone
- (618) 419-0011
- Fax
- (888) 980-2931
- NPI assigned
- Mar 30, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Paul S Havrilka III, FNP
- Title
- FNP/Owner
- Phone
- (618) 419-0011
Practitioners 2
-
Dana Lee Mathis, D.C.
-
Stephanie Kay Shook, D.C.
National Provider Directory
Locations
314 S Poplar St
Unit 864
Centralia, IL 62801
7825A E Grant Rd
Walnut Hill, IL 62893
Phone (618) 545-0707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
211 S Perrine Ave
Centralia, IL 62801-3635
Mailing address
314 S Poplar St Unit 864
Centralia, IL 62801-0848
Phone (618) 419-0011
Other practice location 1
7825A E Grant Rd
Walnut Hill, IL 62893-1613
Phone (618) 545-0707
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All providers in Centralia, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.