# LONG CREEK MEDICAL LLC

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

## Provider details

- **NPI number:** 1871345165
- **Authorized official:** JENNIFER SHAWN MAHANNAH APN (OWNER)
- **Authorized official phone:** (217) 519-3203

## Contact information

- **Practice address:** 2550 S 70TH ST, DECATUR, IL 62521-8742
- **Practice address phone:** (217) 330-0407
- **Mailing address:** 2550 S 70TH ST, DECATUR, IL 62521-8742
- **Mailing address phone:** (217) 330-0407
- **Mailing address fax:** (217) 864-1033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/02/2024
- **Last updated:** 11/26/2025