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Organization

NATIONWIDE MEDICAL NETWORK

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RACHEAL HANNAH (MANAGING DIRECTOR)
(618) 477-9640
Entity
Organization

Contact information

Practice address
1333 CENTRAL PARK DRIVE SUITE 102, O FALLON, IL 62269
(618) 477-4960
Mailing address
4020 GREEN MOUNT CROSSING DR STE 143, O FALLON, IL 62269-7287

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10892503
ARTICLES OF ORGANIZATION
IL
Enumeration date
10/18/2021
Last updated
10/18/2021
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