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CLARK COUNTY FAMILY MEDICINE NPI 1750639480


NPI Information

NPI: 1750639480
Provider Name: CLARK COUNTY FAMILY MEDICINE
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 14D0963098

Address:
890 RIDGELAWN RD
MARTINSVILLE, IL
ZIP 62442
Phone: (217) 382-4191
Get Directions

CLARK COUNTY FAMILY MEDICINE is a family medicine in Martinsville, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CLARK COUNTY FAMILY MEDICINE NPI is 1750639480. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

890 RIDGELAWN RD
MARTINSVILLE, IL
ZIP 62442-399
Phone: (217) 382-4191
Fax: (217) 382-4248

The provider's authorized official is Cathy Jo Galeener .
The authorized official title is Practice Mgr and has the following contact phone number (217) 382-4191.

The CLIA number assigned to this NPI record is 14D0963098 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/28/2012 and was last updated on 8/28/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========001MEDICAIDILLINOIS
2143935MEDICARE PIN
3DR9170OTHERRAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.