NPIMap

Organization Active NPI

Mullin Memorial Health Services LLC

Doing business as Mullin Memorial Rural Health Clinic

  • Rural Health Clinic/Center
  • Manlius, IL
National Provider Identifier
1902977424
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MULLIN MEMORIAL HEALTH SERVICES LLC
Doing business as
Mullin Memorial Rural Health Clinic
Practice address
320 South Second St
Manlius, IL 61338-0324
Phone
(815) 445-2273
Fax
(815) 445-2213
NPI assigned
Nov 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sherry L Desalle, FNPNPI 1336114156
Title
Owner
Phone
(815) 445-2273

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
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

320 South Second St
Manlius, IL 61338-0324

Mailing address

320 South Second St
Manlius, IL 61338-0324
Phone (815) 445-2273

Other names 1

  • MULLIN MEMORIAL RURAL HEALTH CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mullin Memorial Health Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902977424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 SOUTH SECOND ST",
            "city": "MANLIUS",
            "state": "IL",
            "postal_code": "613380324",
            "telephone_number": "815-445-2273",
            "fax_number": "815-445-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 SOUTH SECOND ST",
            "city": "MANLIUS",
            "state": "IL",
            "postal_code": "613380324",
            "telephone_number": "815-445-2273",
            "fax_number": "815-445-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULLIN MEMORIAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESALLE",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-445-2273",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MULLIN MEMORIAL RURAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manlius, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.