# KOKE MILL MEDICAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225289861
- **Authorized official:** J. TRAVIS DOWELL (VICE PRESIDENT HCNA AND OPERATIONS)
- **Authorized official phone:** (217) 788-3342

## Contact information

- **Practice address:** 3132 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7400
- **Practice address phone:** (217) 862-0800
- **Practice address fax:** (217) 862-0871
- **Mailing address:** PO BOX 3428, SPRINGFIELD, IL 62708-3428
- **Mailing address phone:** (800) 577-5368
- **Mailing address fax:** (217) 757-2021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/01/2008
- **Last updated:** 10/01/2008