MEDICARE: MELINDA K BARTHELME NP-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
1	363LF0000X	Family Nurse Practitioner	209000544	IL
2	363LF0000X	Family Nurse Practitioner	277000137	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00465576	OTHER	IL	RAILROAD MEDICARE/PALMETTO GBA

General Provider Information

NPI Number	:	1639104672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA K BARTHELME NP-C

Provider Business Mailing Address
First Line	:	1025 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2403
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W WASHINGTON ST STE 3
Second Line	:
City	:	NEWTON
State	:	IL
Zip	:	62448-1271
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	10/23/2020

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