Roadside Medical, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ROADSIDE MEDICAL, LLC

Doing business as

Roadside Medical Clinic and Lab

Practice address

699 State Route 203
Suite 1
East Saint Louis, IL 62201-1608

Phone

(941) 225-2520

Fax

(888) 860-8609

NPI assigned

Aug 3, 2010

Organization subpart

No

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

Authorized official

Name

Jonathon Witherspoon

Title

Chief Executive Officer

Phone

(941) 225-2520

Specialties & licenses 1

Addresses

Other names 1

• Roadside Medical Clinic and Lab Doing business as

Tax ID family

Roadside Medical Clinic and Lab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Roadside Medical, LLC

  dba Roadside Medical Clinic and Lab

  • Clinic/Center
  • Oklahoma City, OK
  • NPI 1811208366
  NPD tax ID

Locations

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1457665382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8466 LOCKWOOD RIDGE RD",
            "address_2": "#248",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342432951",
            "telephone_number": "941-225-2520",
            "fax_number": "888-860-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 STATE ROUTE 203",
            "address_2": "SUITE 1",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622011608",
            "telephone_number": "941-225-2520",
            "fax_number": "888-860-8609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROADSIDE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "WITHERSPOON",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "941-225-2520"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roadside Medical Clinic and Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kayla Ann Pryor, APRN
• Leah Pulley
• Pure Living Recovery and Rehabilition Center
• Quality Home Care Solutions Inc
• Jewel Radford, RN
• Karnaldo Ross
• Songyoth Sakdisri, MD
• Erin Deneen Sanders
• Charles Scheer, NP
• Bharat Kantilal Shah, M.D.

• Clinic/Center in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.