Abundant Life Medical Clinic, LLC

Primary specialty

Legal MedicineTaxonomy code 173000000X

Legal business name

ABUNDANT LIFE MEDICAL CLINIC, LLC

Practice address

1141 N Cheney St
Taylorville, IL 62568-2741

Phone

(217) 824-2524

Fax

(217) 824-2588

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Miss Gerry A Klinefelter

Title

Office Manager

Phone

(217) 824-2524

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1912910688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 N CHENEY ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682741",
            "telephone_number": "217-824-2524",
            "fax_number": "217-824-2588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 N CHENEY ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682741",
            "telephone_number": "217-824-2524",
            "fax_number": "217-824-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIFE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "KLINEFELTER",
        "authorized_official_first_name": "GERRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "217-824-2524",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Grace Allen, M.A., CF-SLP
• Alicia Altheimer, MD
• Krystal D Baker, HIS
• Joseph Barron, DC
• Linda L. Berck, MS, CCC-SLP/L

• Legal Medicine in Taylorville, IL
• Providers in Taylorville, IL by specialty
• Legal Medicine in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; 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.