Jacksonville Pediatric Associates, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

JACKSONVILLE PEDIATRIC ASSOCIATES, LLC

Practice address

1600 W Walnut St
East Wing, 3Rd Floor
Jacksonville, IL 62650-1136

Phone

(217) 245-5437

Fax

(217) 243-3113

NPI assigned

Oct 2, 2008

Organization subpart

No

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

Authorized official

Name

J. Travis Dowell

Title

Vice President, Hcna and Operations

Phone

(217) 788-3342

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marshall T Hale, M.D.

  • Family Medicine Physician
  • Jacksonville, IL
  • NPI 1245226372
  NPD (past)

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222905600000",
    "number": "1679724181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3428",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627083428",
            "telephone_number": "800-577-5368",
            "fax_number": "217-757-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "address_2": "EAST WING, 3RD FLOOR",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501136",
            "telephone_number": "217-245-5437",
            "fax_number": "217-243-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2008-10-02",
        "status": "A",
        "authorized_official_last_name": "DOWELL",
        "authorized_official_first_name": "J. TRAVIS",
        "authorized_official_title_or_position": "VICE PRESIDENT, HCNA AND OPERATIONS",
        "authorized_official_telephone_number": "217-788-3342"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Crnas Inc
• Jacksonville Family Health Care Lab
• Jacksonville Il Wellness (Jacksonville Wellness)
• Jacksonville Oncology Institute Limited
• Jacksonville Pediatric Associates, LLC
• Jacksonville School Dist 117
• Jacksonville, LLC (Internal Medicine Clinic of Jacksonville)
• Jacksonville, LLC (Jacksonville Family Practice)
• Jacksonville, LLC (Jacksonville Family Medical Associates)
• Jacksonville, LLC

• Rural Health Clinic/Center in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; 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.