Family Medicine of McLeansboro LLC
Organization Active NPI Family Nurse Practitioner · McLeansboro, IL
NPI 1801920889 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1801920889
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- FAMILY MEDICINE OF MCLEANSBORO LLC
- Practice address
- 208 S Washington St
McLeansboro, IL 62859-1139 - Phone
- (618) 643-2835
- Fax
- (618) 643-2891
- NPI assigned
- Mar 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Michael S Davenport, FNP
- Title
- Manager
- Phone
- (618) 927-8714
National Provider Directory
Locations
208 S Washington St
Mc Leansboro, IL 62859
Phone (618) 643-2835
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | IL | Yes |
Addresses
Primary practice location
208 S Washington St
McLeansboro, IL 62859-1139
Mailing address
208 South Washington Street
McLeansboro, IL 62859
Phone (618) 643-2835
Other providers in McLeansboro, IL
- Crossroads Physician Corp
- Hamilton County Health Department
- Hamilton Memorial Hospital District
- Hamilton Memorial Nursing and Rehabilitation Center, L.L.C.
- Hamilton Memorial Nursing Center
- Alec Bruce Hood
All providers in McLeansboro, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.