Med Contract, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MED CONTRACT, INC.

Practice address

113 W Main
Ridgway, IL 62978

Phone

(618) 272-3300

Fax

(618) 272-3700

NPI assigned

Sep 4, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Jamie Peterson

Title

President

Phone

(618) 273-2100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ridgway Family Medicine Clinic Doing business as

Locations

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200960000000",
    "number": "1356535397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MAIN STREET",
            "address_2": "P O BOX 548",
            "city": "RIDGWAY",
            "state": "IL",
            "postal_code": "629790548",
            "telephone_number": "618-272-3300",
            "fax_number": "618-272-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W MAIN",
            "city": "RIDGWAY",
            "state": "IL",
            "postal_code": "62978",
            "telephone_number": "618-272-3300",
            "fax_number": "618-272-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED CONTRACT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2008-01-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-273-2100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361037154",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIF",
            "identifier": "K05588",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridgway Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Jo Fromm, RPH
• Gallatin County Ambulance LLC
• Gallatin Manor LLC
• James Austin Koester
• Sarah Elizabeth Lawler, COTA/L
• PRN Pharmacies LTD
• Ridgway Rehabilitation and Nursing Center, LLC
• Andrea Lyn Shaw
• Samuel Earl Shearer, R.PH., BCGP

• All providers in Ridgway, IL
• Family Medicine Physician in Illinois

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