Jean L. Walsh Family Practitioner, LTD.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-089648 Issued in IL

Legal business name

JEAN L. WALSH FAMILY PRACTITIONER, LTD.

Practice address

16151 Weber Road
Suite 201
Crest Hill, IL 60403-0863

Phone

(815) 838-2888

Fax

(815) 838-0222

NPI assigned

Aug 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jean L Walsh, D.O.NPI 1164648614

Title

Family Practitioner

Phone

(815) 838-2888

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jean L Walsh, D.O.

  • Family Medicine Physician
  • Hinckley, IL
  • NPI 1164648614
  NPD (past) Authorized official

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225065600000",
    "number": "1922115377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16151 WEBER RD",
            "address_2": "SUITE 201",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604030863",
            "telephone_number": "815-838-2888",
            "fax_number": "815-838-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16151 WEBER ROAD",
            "address_2": "SUITE 201",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604030863",
            "telephone_number": "815-838-2888",
            "fax_number": "815-838-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEAN L. WALSH FAMILY PRACTITIONER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-10-27",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "FAMILY PRACTITIONER",
        "authorized_official_telephone_number": "815-838-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-089648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02226675",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Crest Hill, IL
• Providers in Crest Hill, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2008; 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.