NPIMap

Organization Active NPI

Melanie Illich MD PA

  • Psychiatry Physician
  • Waco, TX
National Provider Identifier
1699879288
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
J2104 Issued in TX
Legal business name
MELANIE ILLICH MD PA
Practice address
213A Old Hewitt Rd
Waco, TX 76712
Phone
(254) 772-2006
Fax
(254) 772-2011
NPI assigned
Sep 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2013

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

Authorized official

Name
Dr. Melanie B Illich, MDNPI 1982893665
Title
President
Phone
(254) 772-2006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X J2104 TX Primary

Addresses

Primary practice location

213A Old Hewitt Rd
Waco, TX 76712

Mailing address

PO Box 23289
Waco, TX 76702
Phone (254) 772-2006

Other identifiers 2

IdentifierTypeStateIssuer
113408204MedicaidTX
157845201MedicaidTX

Other names 1

  • Melanie Illich MD PA Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1699879288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23289",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76702",
            "telephone_number": "254-772-2006",
            "fax_number": "254-772-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213A OLD HEWITT RD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76712",
            "telephone_number": "254-772-2006",
            "fax_number": "254-772-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELANIE ILLICH MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "ILLICH",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "254-772-2006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "J2104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113408204",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157845201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Melanie Illich MD PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; 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.