Organization Active NPI

Midwest Neurology Associates, S.C.

  • Specialist
  • Decatur, IL
National Provider Identifier
1255587176
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036093353 Issued in IL
Legal business name
MIDWEST NEUROLOGY ASSOCIATES, S.C.
Practice address
302 W Hay St
Suite Ll110
Decatur, IL 62526-4167
Phone
(217) 872-7000
NPI assigned
Aug 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Heather Lynice Daugherty
Title
Office Manager
Phone
(217) 872-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 036093353 IL Primary

Addresses

Primary practice location

302 W Hay St
Suite Ll110
Decatur, IL 62526-4167

Mailing address

302 W Hay St
Suite Ll110
Decatur, IL 62526-4167
Phone (217) 872-7000

Other identifiers 1

IdentifierTypeStateIssuer
036093353MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1255587176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W HAY ST",
            "address_2": "SUITE LL110",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264167",
            "telephone_number": "217-872-7000",
            "fax_number": "217-233-1564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W HAY ST",
            "address_2": "SUITE LL110",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264167",
            "telephone_number": "217-872-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST NEUROLOGY ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-12",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "LYNICE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "217-872-7000"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036093353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093353",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; 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.