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Organization
MEDICAL ASSOCIATES OF JERSEYVILLE, LTD.
Active
Organization
MEDICAL ASSOCIATES OF JERSEYVILLE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRY LYNN BENWARE R.N. (PRACTICE MANAGER)
(618) 498-7108
Entity
Organization
Contact information
Practice address
270 MAPLE SUMMIT RD, MCDOW BUILDING, JERSEYVILLE, IL 62052-2004
(618) 498-7108
(618) 498-7919
Mailing address
PO BOX 364, JERSEYVILLE, IL 62052-0364
(618) 498-7108
(618) 498-7919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042007207
CORPORATE LICENSE
IL
Enumeration date
02/06/2006
Last updated
04/24/2008
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