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General NPI Number Information
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NPI Number | 1750532362
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Entity Type | Organization
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Legal Business Name | MEMORIAL EXPRESSCARE, LLC
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 3132 OLD JACKSONVILLE RD SUITE 110
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7400
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Country | US
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Telephone | 217-862-0062
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Fax | 217-862-0064
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Provider Business Mailing Address
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Address Line | PO BOX 3428
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City | SPRINGFIELD
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State | IL
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Zip | 62708-3428
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Country | US
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Telephone | 800-577-5368
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Fax | 217-757-2021
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Authorized Official
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Title or Position | VICE PRESIDENT, BUSINESS DEVELOPMEN
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Name | KEVIN ENGLAND
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Credential |
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Telephone | 217-788-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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