Organization
BACKROAD HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL S HAVRILKA III FNP (FNP/OWNER)
(618) 419-0011
Entity
Organization
Contact information
Practice address
211 S PERRINE AVE, CENTRALIA, IL 62801-3635
(618) 419-0011
(888) 980-2931
Mailing address
314 S POPLAR ST UNIT 864, CENTRALIA, IL 62801-0848
(618) 419-0011
(888) 960-2931
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/30/2016
Last updated
03/18/2019
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