# JACKSONVILLE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jacksonville Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528210705
- **Authorized official:** J. TRAVIS DOWELL (VICE PRESIDENT, HCNA AND OPERATIONS)
- **Authorized official phone:** (217) 788-3342

## Contact information

- **Practice address:** 800 W STATE ST, JACKSONVILLE, IL 62650-2290
- **Practice address phone:** (217) 243-9471
- **Practice address fax:** (217) 243-5359
- **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 |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/21/2008
- **Last updated:** 10/21/2008