Healthcare Provider Details

I. General information

NPI: 1518172162
Provider Name (Legal Business Name): SANGAMON COUNTY PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CHATHAM RD STE 100
SPRINGFIELD IL
62704-1497
US

IV. Provider business mailing address

315 CHATHAM RD STE 100
SPRINGFIELD IL
62704-1497
US

V. Phone/Fax

Practice location:
  • Phone: 217-698-5400
  • Fax: 217-698-2800
Mailing address:
  • Phone: 217-698-5400
  • Fax: 217-698-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JEFFREY ANDREW WINGHAM
Title or Position: PRESIDENT
Credential: DC
Phone: 217-698-5400