Healthcare Provider Details

I. General information

NPI: 1851586192
Provider Name (Legal Business Name): HUMPHREYS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SAINT FRANCIS WAY
LITCHFIELD IL
62056-1780
US

IV. Provider business mailing address

801 E CARPENTER ST PO BOX 1977
SPRINGFIELD IL
62702-5323
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-8798
  • Fax: 217-324-8622
Mailing address:
  • Phone: 217-544-6464
  • Fax: 217-757-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0361131128
License Number StateIL

VIII. Authorized Official

Name: DR. AARON HUMPHREYS
Title or Position: OWNER
Credential: M.D.
Phone: 217-324-8798