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General NPI Number Information
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NPI Number | 1841237583
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Entity Type | Organization
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Legal Business Name | DAVID P DAVIS MEDICINE, PC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 890 RIDGELAWN RD
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City | MARTINSVILLE
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State | IL
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Zip | 62442-0399
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Country | US
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Telephone | 217-382-4191
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Fax | 217-382-4248
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Provider Business Mailing Address
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Address Line | 890 RIDGELAWN RD PO BOX 399
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City | MARTINSVILLE
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State | IL
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Zip | 62442-0399
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Country | US
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Telephone | 217-382-4191
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Fax | 217-382-4248
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID PAUL DAVIS
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Credential | MD
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Telephone | 217-382-4191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 036086811
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License Number State | IL
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