Individual
JIMMIE MARQUETTE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-6880
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-5101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036085766
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062839
UMWA
IL
01
—
014146
HEALTH ALLIANCE
IL
01
—
02922981
BCBS
IL
05
—
036085766
—
IL
01
—
085766
OSF HEALTHPLANS
IL
01
—
110200800
RR MEDICARE PIN
IL
01
—
1942315197
NPI CLINIC NUMBER
IL
01
—
200397
BLACK LUNG
IL
01
—
207537
HEALTH LINK
IL
01
—
CG5172
RR MEDICARE GROUP#
IL
01
—
IL0112
JOHN DEERE
IL
Enumeration date
08/29/2006
Last updated
04/13/2021
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