Organization
MEMORIAL PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS J DOWELL (VICE PRESIDENT, MPS)
(217) 788-3342
Entity
Organization
Contact information
Practice address
1606 W LAFAYETTE AVE, JACKSONVILLE, IL 62650-3707
(217) 245-1421
(217) 243-1699
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148988
RHC MEDICARE PTAN
—
Enumeration date
10/24/2012
Last updated
10/23/2019
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