Spoon River Family Practice Center, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SPOON RIVER FAMILY PRACTICE CENTER, INC

Practice address

45 E Side SQ
Suite 102
Canton, IL 61520-2671

Phone

(309) 647-9980

Fax

(309) 647-7792

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Linda Kay Forestier, M.D.

Title

President

Phone

(309) 647-9980

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437268604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 E SIDE SQ",
            "address_2": "SUITE 102",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202671",
            "telephone_number": "309-647-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 E SIDE SQ",
            "address_2": "SUITE 102",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202671",
            "telephone_number": "309-647-9980",
            "fax_number": "309-647-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPOON RIVER FAMILY PRACTICE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORESTIER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-647-9980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE PROVIDER #",
            "identifier": "IL0101",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP #",
            "identifier": "DA4719",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "0002932001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PROVDIER",
            "identifier": "014152",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kara Dean Simpson, LCSW
• McKenzie Skaggs
• Carissa Elizabeth Slobodecki, DPT
• Jimmie Marquette Smith, MD
• Spoon River Counseling & Wellness PLLC
• Spoon River Hearing Services Inc
• Stan Buczko RPH
• Andrea Steliga-Phillips, PSYD
• Amanda L Stephenson, DPT
• Fordyce Edward Stivers, MD

• Family Medicine Physician in Canton, IL
• Providers in Canton, IL by specialty
• Family Medicine Physician in Illinois

• 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.