NPIMap

Organization Active NPI

Ronald Weems Jr. P.C.

  • General Practice Dentistry
  • O Fallon, IL
National Provider Identifier
1700100930
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025159 Issued in IL
Legal business name
RONALD WEEMS JR. P.C.
Practice address
3750 Green Mount Crossing Dr
O Fallon, IL 62269-7293
Phone
(618) 628-7050
Fax
(618) 628-6957
NPI assigned
Mar 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2013

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

Authorized official

Name
Amanda Henderson Jr.
Title
Owner
Phone
(618) 288-6201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019025159 IL Primary

Addresses

Primary practice location

3750 Green Mount Crossing Dr
O Fallon, IL 62269-7293

Mailing address

26 Ginger Creek Pkwy
PO Box 430
Glen Carbon, IL 62034-3502
Phone (618) 288-6201

Other names 1

  • Shiloh Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ronald Weems Jr PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the 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": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1700100930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 GINGER CREEK PKWY",
            "address_2": "PO BOX 430",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-288-6201",
            "fax_number": "618-288-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 GREEN MOUNT CROSSING DR",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697293",
            "telephone_number": "618-628-7050",
            "fax_number": "618-628-6957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD WEEMS JR. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-288-6201",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shiloh Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.