Julia A Bancroft, DO
Individual provider Active NPI Family Medicine Physician · Sesser, IL
NPI 1669459129 · NPPES record last updated Oct 25, 2011
Key facts
- NPI
- 1669459129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036098406 (IL)
- Practice address
- 6294 State Hwy 154
Sesser, IL 62884 - Phone
- (618) 625-6979
- Fax
- (618) 625-5362
- NPI assigned
- Dec 27, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036098406 | IL | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036098406 | IL | Yes |
Addresses
Primary practice location
6294 State Hwy 154
Sesser, IL 62884
Mailing address
PO Box 155
Christopher Greater Area Rural Health Planning Corp
Christopher, IL 62822
Phone (618) 724-2401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036098406 | Medicaid | IL | |
| 049587 | Other | HEALTH ALLIANCE | |
| 413721 | Other | HEALTHLINK |
Other providers in Sesser, IL
- Kasey Lynn Adams
- Ashley Lynn Agnew
- Caitlyn Barr
- Amy Bratcher
- Patrick B Cameron
- Christopher Greater Area Rural Health Planning Corporation
- Christopher Greater Area Rural Health Planning Corporation
All providers in Sesser, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.