Physical Medicine Clinic of Granite City LTD

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

209007631 Issued in IL

Legal business name

PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD

Practice address

2861 Madison Ave
Granite City, IL 62040-3614

Phone

(618) 877-4000

Fax

(618) 877-0874

NPI assigned

Sep 28, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Bridget Brasfield, D.C.

Title

Owner/Chiropractor

Phone

(618) 877-4000

Specialties & licenses 2

Addresses

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Physical Medicine Clinic of Granite City LTD

  • Non-Pharmacy Dispensing Site
  • Granite City, IL
  • NPI 1083986541
  NPPES parent name

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1992039747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2861 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403614",
            "telephone_number": "618-877-4000",
            "fax_number": "618-877-0874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403614",
            "telephone_number": "618-877-4000",
            "fax_number": "618-877-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "BRASFIELD",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "618-877-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009646",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209007631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice M Pautler, RD,LD
• Albert Pelate, RPH
• Oscar Adrian Perez, PA-C
• Phillips Chiropractic LLC
• Physical Medicine Clinic of Granite City LTD
• Victor Manuel Pinones, D.M.D
• Adriana Poenitzsch, RPH
• Heather Roan Porter, PTA
• Donna Kay Porterfield, D.M.D.
• David L Priebe, M.D.

• Adult Health Nurse Practitioner in Granite City, IL
• Providers in Granite City, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; 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.