Marilyn Stombaugh, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

4107 S Water Tower PL
Mount Vernon, IL 62864-6293

Phone

(618) 244-0031

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Skin Care Center of Southern Il LLC

  • Dermatopathology Physician
  • Mount Vernon, IL
  • NPI 1669599841
  NPD

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669559290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14739 N COUNTY FARM LN",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649895",
            "telephone_number": "618-241-9619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4107 S WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-244-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOMBAUGH",
        "first_name": "MARILYN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sterling Emergency Physicians of Illinois, S.C
• Loretta M Stevens, RNC QMHP
• Roxanna Elise Stevens, BC-FNP
• Jeanne Ann Stich, BSN, RN
• David L Stittsworth, CRNA
• Rose Marie Straeter, IBCLC
• Laura Kay Stroud, C.O.T.A.
• Monique Stuckey, BA
• Keith Allen Suedmeyer, LCSW
• Summersville SD 79

• Medical Physician Assistant in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.