MEDICARE: MR. ROLLIN MORRIS PERKINS IV PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1649453259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROLLIN MORRIS PERKINS IV PA-C

Provider Business Mailing Address
First Line	:	220 S PARK AVE
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-3612
Country	:	US
Telephone Number	:	618-988-9777
Fax Number	:	618-988-9097

Provider Business Practice Location Address
First Line	:	220 S PARK AVE
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-3612
Country	:	US
Telephone Number	:	618-988-9777
Fax Number	:	618-988-9097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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