Backroad Health Care Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 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

Last updated

Mar 18, 2019By 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. Paul S Havrilka III, FNP

Title

FNP/Owner

Phone

(618) 419-0011

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dana Lee Mathis, D.C.

  • Chiropractor
  • Centralia, IL
  • NPI 1619024650
  NPD (past)
• Stephanie Kay Shook, D.C.

  • Chiropractor
  • Centralia, IL
  • NPI 1336327105
  NPD (past)

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1134582018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 S POPLAR ST UNIT 864",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628010848",
            "telephone_number": "618-419-0011",
            "fax_number": "888-960-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S PERRINE AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013635",
            "telephone_number": "618-419-0011",
            "fax_number": "888-980-2931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7825A E Grant Rd",
            "address_purpose": "LOCATION",
            "city": "Walnut Hill",
            "state": "IL",
            "postal_code": "628931613",
            "country_code": "US",
            "telephone_number": "618-545-0707",
            "fax_number": "888-802-1633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BACKROAD HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "HAVRILKA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "FNP/OWNER",
        "authorized_official_telephone_number": "618-419-0011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Atchison
• Haley Aud
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• Aziz Rahman MD Facp PC
• B C Stufflebam, MD, LLC
• Bandys Apothecary Shops Inc (Bandy's Pharmacy II)
• Wendy Barban-Jourdan, BEHAVIOR THERAPIST
• Kaitlin Barbee
• Tiana Barbee
• Chapyn Barnett

• Family Nurse Practitioner in Centralia, IL
• Providers in Centralia, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.

Verify at the official NPI Registry.