Active NPI
Jac Stores Inc
- Community/Retail Pharmacy
- Mt Zion, IL
National Provider Identifier
1699119644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- JAC STORES INC
- Practice address
- 1410 Village Pkwy
Mt Zion, IL 62549-1253 - Phone
- (217) 864-0910
- NPI assigned
- Apr 22, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Edward Falk
- Title
- President/Owner
- Phone
- (217) 362-6226
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
1410 Village Pkwy
Mt Zion, IL 62549-1253
Mailing address
2245 W Mound Rd
Decatur, IL 62526-9367
Other names 1
- Sav Mor Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100811000759 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 8921132051 |
13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Nokomis, IL; Robinson, IL; Tuscola, IL; Virden, IL |
Other NPIs on the same Medicare enrollment 13
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366588800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1382572800000",
"number": "1699119644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2245 W MOUND RD",
"city": "DECATUR",
"state": "IL",
"postal_code": "625269367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1410 VILLAGE PKWY",
"city": "MT ZION",
"state": "IL",
"postal_code": "625491253",
"telephone_number": "217-864-0910"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JAC STORES INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-04-22",
"last_updated": "2013-10-24",
"status": "A",
"authorized_official_last_name": "FALK",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "EDWARD",
"authorized_official_title_or_position": "PRESIDENT/OWNER",
"authorized_official_telephone_number": "217-362-6226"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Sav Mor Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mt Zion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.