NPIMap

Organization Active NPI

Jackson Street Family Practice Center, LTD

  • Family Medicine Physician
  • Marion, IL
National Provider Identifier
1356355259
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JACKSON STREET FAMILY PRACTICE CENTER, LTD
Practice address
3331 W Deyoung St
Suite 207
Marion, IL 62959-5896
Phone
(618) 998-7000
NPI assigned
Jul 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Karen Strack, D.O.NPI 1700855871
Title
Officer
Phone
(618) 998-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X IL Primary

Addresses

Primary practice location

3331 W Deyoung St
Suite 207
Marion, IL 62959-5896

Mailing address

PO Box 446
Murphysboro, IL 62966-0446
Phone (618) 924-5149

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356355259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629660446",
            "telephone_number": "618-924-5149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 W DEYOUNG ST",
            "address_2": "SUITE 207",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595896",
            "telephone_number": "618-998-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON STREET FAMILY PRACTICE CENTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STRACK",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "618-998-7000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

  • 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.