Organization
JACKSONVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J. TRAVIS DOWELL (VICE PRESIDENT, HCNA AND OPERATIONS)
(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
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/02/2008
Last updated
10/02/2008
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