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NPI Code Detail

MEDICARE: MEMORIAL PHYSICIAN SERVICES

MEDICARE: MEMORIAL PHYSICIAN SERVICES
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
1261QR1300XRural Health Clinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1148905OTHERRHC MEDICARE PTAN

General Provider Information

NPI Number : 1558614867
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL PHYSICIAN SERVICES
Provider Business Mailing Address
First Line : PO BOX 3428
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62708-3428
Country : US
Telephone Number : 800-577-5368
Fax Number : 217-757-2021
Provider Business Practice Location Address
First Line : 15 FOUNDERS LN
Second Line : SUITE 100
City : JACKSONVILLE
State : IL
Zip : 62650-3919
Country : US
Telephone Number : 217-243-0300
Fax Number : 217-245-6775
Authorized Official
Title or Position : VICE PRESIDENT, MPS
Name : JAMES T DOWELL
Credential :
Telephone Number : 217-788-3342
Provider Enumeration Date : 10/24/2012
Last Update Date : 02/11/2021

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Directions to “MEMORIAL PHYSICIAN SERVICES ” Practice Location

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