Organization
FAMILY MEDICINE OF MCLEANSBORO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL S DAVENPORT FNP (MANAGER)
(618) 927-8714
Entity
Organization
Contact information
Practice address
208 S WASHINGTON ST, MCLEANSBORO, IL 62859-1139
(618) 643-2835
(618) 643-2891
Mailing address
208 SOUTH WASHINGTON STREET, MCLEANSBORO, IL 62859
(618) 643-2835
(618) 643-2891
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Enumeration date
03/14/2007
Last updated
08/22/2020
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