NPIMap

Organization Active NPI

Ronald Weems Jr P.C.

Doing business as Wood River Family Dental

  • General Practice Dentistry
  • Wood River, IL
National Provider Identifier
1972762367
Registry record updated May 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025159 Issued in IL
Legal business name
RONALD WEEMS JR P.C.
Doing business as
Wood River Family Dental
Practice address
1915 Vaughn Road
Wood River, IL 62095
Phone
(618) 259-2007
Fax
(618) 259-2675
NPI assigned
Jun 2, 2008
Last updated
May 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2012

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

Authorized official

Name
Amanda Henderson
Title
Business Assistant
Phone
(618) 259-2007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019025159 IL Primary

Addresses

Primary practice location

1915 Vaughn Road
Wood River, IL 62095

Mailing address

26 Ginger Creek Pkwy
PO Box 430
Glen Carbon, IL 62034-3502
Phone (618) 288-6201

Other names 1

  • Wood River Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ronald Weems Jr PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1915 Vaughn Rd
Wood River, IL 62095
Phone (618) 259-2007

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": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1972762367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 GINGER CREEK PKWY",
            "address_2": "PO BOX 430",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-288-6201",
            "fax_number": "618-288-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 VAUGHN ROAD",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "62095",
            "telephone_number": "618-259-2007",
            "fax_number": "618-259-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD WEEMS JR P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS ASSISTANT",
        "authorized_official_telephone_number": "618-259-2007"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wood River Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wood River, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; 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.