Individual
RYAN L JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 HEALTH CARE DR, GREENVILLE, IL 62246-1154
(618) 664-1230
Mailing address
PO BOX 1268, EFFINGHAM, IL 62401-1268
(217) 342-4151
(217) 342-4133
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036103305
IL
208000000X
Pediatrics Physician
036103305
IL
208M00000X
Hospitalist Physician
Primary
036103305
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103305
—
IL
01
—
0460911
HEALTHLINK #
IL
01
—
076042
HEALTH ALLIANCE #
IL
01
—
110232704
RAILROAD MEDICARE/PALMETTO GBA
IL
01
—
2523659
BC/BS #
IL
Enumeration date
07/11/2006
Last updated
05/10/2019
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