Kewanee Medical Clinic – Internal Medicine Physician

Key facts

NPI: 1730375593
Entity type: Organization (NPI type 2)
Primary specialty: Internal Medicine Physician 207R00000X
Legal business name: KEWANEE MEDICAL CLINIC
Practice address: 204 W South St
Kewanee, IL 61443-3661
Phone: (309) 853-5360
Fax: (309) 853-5106
NPI assigned: Sep 14, 2007
Organization subpart: No

Authorized official

Name: Mr. James S Lindbom, MD
Title: Owner
Phone: (309) 853-5360

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	207R00000X			Yes

Addresses

Primary practice location

204 W South St
Kewanee, IL 61443-3661

Mailing address

204 W South St
Kewanee, IL 61443-3661
Phone (309) 853-5360

Other identifiers

Identifier	Type	State	Issuer
036098462	Medicaid	IL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2007.

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1730375593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W SOUTH ST",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614433661",
            "telephone_number": "309-853-5360",
            "fax_number": "309-853-5106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W SOUTH ST",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614433661",
            "telephone_number": "309-853-5360",
            "fax_number": "309-853-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEWANEE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "LINDBOM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-853-5360",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098462",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kewanee, IL

All providers in Kewanee, IL · Internal Medicine Physician in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.