Midwest Regional Neonatology Associates, LLC

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

36112572IL Issued in IL

Legal business name

MIDWEST REGIONAL NEONATOLOGY ASSOCIATES, LLC

Practice address

405 W Jackson St
Carbondale, IL 62901-1462

Phone

(618) 543-0721

Fax

(618) 457-4735

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Rebecca G Bolen, CPC

Title

Office Manager

Phone

(618) 549-8464

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609937127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 W MAIN ST",
            "address_2": "#306",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012123",
            "telephone_number": "618-549-8464",
            "fax_number": "618-457-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W JACKSON ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011462",
            "telephone_number": "618-543-0721",
            "fax_number": "618-457-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST REGIONAL NEONATOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOLEN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-549-8464",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "36112572IL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "03932033",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Mertes
• Sidney C Metzger
• Madison P Meyer
• Sameer Nasir Mian, DO
• Steve Middleton, PT, DPT, ATC
• Ana Migone, M.D.
• Pamela Renee Milano, M.D.
• Jessica Milburn, NP
• Rachel Miles, MSW
• Kathy Ann Mileur, PT

• Neonatal-Perinatal Medicine Physician in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Neonatal-Perinatal 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.