Memorial Physician Services

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

MEMORIAL PHYSICIAN SERVICES

Practice address

1606 W Lafayette Ave
Jacksonville, IL 62650-3707

Phone

(217) 245-1421

Fax

(217) 243-1699

NPI assigned

Oct 24, 2012

Last updated

Oct 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Travis J Dowell

Title

Vice President, MPS

Phone

(217) 788-3342

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1881947174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3428",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627083428",
            "telephone_number": "800-577-5368",
            "fax_number": "217-757-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 W LAFAYETTE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503707",
            "telephone_number": "217-245-1421",
            "fax_number": "217-243-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-24",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "DOWELL",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT, MPS",
        "authorized_official_telephone_number": "217-788-3342"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHC MEDICARE PTAN",
            "identifier": "148988",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Memorial Industrial Rehabilitation of Jacksonville
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• Memorial Physician Services
• Memorial Physician Services
• Memorial Physician Services
• Mental Health Centers of Central Illinois (Memorial Behavioral Health - Jacksonville)
• Mental Health Centers of Central Illinois (Memorial Behavioral Health - Jacksonville)
• Midwest Eye Associates, LLC
• Janet Pauline Milburn, LCPC
• Molly Beth Miles

• Rural Health Clinic/Center in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.