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
1	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148988	OTHER		RHC MEDICARE PTAN

General Provider Information

NPI Number	:	1881947174
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	:	1606 W LAFAYETTE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3707
Country	:	US
Telephone Number	:	217-245-1421
Fax Number	:	217-243-1699

Authorized Official
Title or Position	:	VICE PRESIDENT, MPS
Name	:	TRAVIS J DOWELL
Credential	:
Telephone Number	:	217-788-3342

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/23/2019

Similar Medicare Providers

1902804495 — DR. DAVID D COULTAS M.D.
Practice Location Address:

1606 W LAFAYETTE AVE
JACKSONVILLE, IL
62650-3707

Practice Phone: 217-245-1421
Practice Fax: 217-243-1699

1013980101 — DR. TARA JEAN RAMSEY M.D.
Practice Location Address:

1606 W LAFAYETTE AVE , SUITE D
JACKSONVILLE, IL
62650-3707

Practice Phone: 217-479-0290
Practice Fax: 217-479-0292

1518976497 — HEALTHCARE NETWORK ASSOCIATES
Practice Location Address:

1606 W LAFAYETTE AVE
JACKSONVILLE, IL
62650-3707

Practice Phone: 217-245-1421
Practice Fax: 217-243-1699

1437301611 — JACKSONVILLE, LLC
Practice Location Address:

1606 W LAFAYETTE AVE
JACKSONVILLE, IL
62650-3707

Practice Phone: 217-245-1421
Practice Fax: 217-243-1699

1154522738 — JAMES C. CUNNINGHAM D.O.
Practice Location Address:

3707 BURNT PINE DR
JACKSONVILLE, FL
32224-0855

Practice Phone: 952-595-1100
Practice Fax: 612-294-4903

1689139040 — MR. TAYLOR MAX WADE FNP-C
Practice Location Address:

1505 PELHAM RD S STE 2
JACKSONVILLE, AL
36265-3707

Practice Phone: 256-435-7300
Practice Fax: 256-435-7305

Directions to “MEMORIAL PHYSICIAN SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.