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NPI Code Detail

MEDICARE: CHRISTINE R WATSON PA-C

MEDICARE: CHRISTINE R WATSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085002234IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CB3700OTHERILRAILROAD MEDICARE GROUP
5P00121463OTHERILRAILROAD MEDICARE PROV #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1665231OTHERILHEALTHLINK PROVIDER NUMBER
2371359450OTHERILFEDERAL EMPLOYER ID NUMBE
4K06735OTHERILUMWA PROVIDER NUMBER

General Provider Information

NPI Number : 1013943760
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE R WATSON PA-C
Provider Business Mailing Address
First Line : 2000 LAKE AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-7401
Country : US
Telephone Number : 815-337-7100
Fax Number : 815-337-4790
Provider Business Practice Location Address
First Line : 2000 LAKE AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-7401
Country : US
Telephone Number : 815-337-7100
Fax Number : 815-337-4790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 02/19/2009

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Directions to “ CHRISTINE R WATSON PA-C” Practice Location

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