NPIMap

Organization Active NPI

Johnston City Medical Clinic, S. C.

  • Rural Health Clinic/Center
  • Johnston City, IL
National Provider Identifier
1962428516
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
JOHNSTON CITY MEDICAL CLINIC, S. C.
Practice address
201 W Broadway Blvd
Johnston City, IL 62951-1427
Phone
(618) 983-6911
Fax
(618) 983-6913
NPI assigned
Jul 15, 2006
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
Dr. Khalid Javed, M.D.NPI 1174529663
Title
Administrator
Phone
(618) 983-6911

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 IL Primary

Addresses

Primary practice location

201 W Broadway Blvd
Johnston City, IL 62951-1427

Mailing address

201 W Broadway Blvd
P. O. Box 209
Johnston City, IL 62951-1427
Phone (618) 983-6911

National Provider Directory

National Provider Directory

Locations

201 W Broadway Blvd
Johnston City, IL 62951
Phone (618) 983-6911

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962428516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W BROADWAY BLVD",
            "address_2": "P. O. BOX 209",
            "city": "JOHNSTON CITY",
            "state": "IL",
            "postal_code": "629511427",
            "telephone_number": "618-983-6911",
            "fax_number": "618-983-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W BROADWAY BLVD",
            "city": "JOHNSTON CITY",
            "state": "IL",
            "postal_code": "629511427",
            "telephone_number": "618-983-6911",
            "fax_number": "618-983-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSTON CITY MEDICAL CLINIC, S. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JAVED",
        "authorized_official_first_name": "KHALID",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-983-6911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnston City, 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.