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Organization

MEMORIAL PHYSICIAN SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES T DOWELL (VICE PRESIDENT, MPS)
(217) 788-3342
Entity
Organization

Contact information

Practice address
1602 W LAFAYETTE AVE, JACKSONVILLE, IL 62650-1007
(217) 243-7200
(217) 243-6165
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021

Taxonomy

Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
148906
RHC MEDICARE PTAN
Enumeration date
10/24/2012
Last updated
10/26/2012
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