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NPI Code Detail

MEDICARE: JANET S WHITE PA C

MEDICARE: JANET S WHITE 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 Assistant085002865IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1211448OTHERILMEDICARE GROUP NUMBER

General Provider Information

NPI Number : 1629189238
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANET S WHITE PA C
Provider Business Mailing Address
First Line : 513 N MAIN ST
Second Line :
City : ANNA
State : IL
Zip : 62906-1668
Country : US
Telephone Number : 618-833-4471
Fax Number : 618-833-6267
Provider Business Practice Location Address
First Line : 211 N BROADWAY
Second Line :
City : GOREVILLE
State : IL
Zip : 62939-2323
Country : US
Telephone Number : 618-995-1002
Fax Number : 618-995-1133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 06/21/2023

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Directions to “ JANET S WHITE PA C” Practice Location

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