Organization Active NPI

Airline Care Clinic PLLC

  • Family Nurse Practitioner
  • East Alton, IL
National Provider Identifier
1992556427
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
AIRLINE CARE CLINIC PLLC
Practice address
33 E Airline Dr
East Alton, IL 62024-1703
Phone
(618) 908-8602
NPI assigned
Apr 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Authorized official

Name
Elizabeth Dykeman
Title
Owner
Phone
(314) 374-9965

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

33 E Airline Dr
East Alton, IL 62024-1703

Mailing address

33 E Airline Dr
East Alton, IL 62024-1703

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2345056Airline Care Clinic, PLLC33 E Airline Dr, East Alton, IL 62024Certificate of waiverJun 3, 2028

National Provider Directory

National Provider Directory

Locations

33 E Airline Dr
East Alton, IL 62024
Phone (618) 258-7600

Practitioners & affiliated clinicians

Practitioners 1

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": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1992556427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 E AIRLINE DR",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 E AIRLINE DR",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620241703",
            "telephone_number": "618-908-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AIRLINE CARE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "DYKEMAN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-374-9965"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.