Organization
MEDICAL ASSOCIATES OF JERSEYVILLE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRY LYNN BENWARE R.N. (PRACTICE MANAGER)
(618) 498-7108
Entity
Organization
Contact information
Practice address
270 MAPLE SUMMIT RD, MCDOW BUILDING, JERSEYVILLE, IL 62052-2004
(618) 498-7108
(618) 498-7919
Mailing address
PO BOX 364, JERSEYVILLE, IL 62052-0364
(618) 498-7108
(618) 498-7919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042007207
CORPORATE LICENSE
IL
Enumeration date
02/06/2006
Last updated
04/24/2008
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