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General NPI Number Information
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NPI Number | 1225172224
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD HEALTH PARTNERS, LLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 1836 S MACARTHUR BLVD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4030
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Country | US
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Telephone | 217-789-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 S MACARTHUR BLVD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4030
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Country | US
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Telephone | 217-789-1411
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROBERT H JURANEK
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Credential | MD
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Telephone | 217-789-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042007921
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License Number State | IL
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