Organization
LONG CREEK MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SHAWN MAHANNAH APN (OWNER)
(217) 519-3203
Entity
Organization
Contact information
Practice address
2550 S 70TH ST, DECATUR, IL 62521-8742
(217) 330-0407
Mailing address
2550 S 70TH ST, DECATUR, IL 62521-8742
(217) 330-0407
(217) 864-1033
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/02/2024
Last updated
11/26/2025
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