HEALTHCARE NETWORK ASSOCIATES OF SANGAMON NPI 1588675482

NPI Information

HEALTHCARE NETWORK ASSOCIATES OF SANGAMON is a multi-specialty clinic center in Springfield, IL. HEALTHCARE NETWORK ASSOCIATES OF SANGAMON NPI is 1588675482. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Memorial Express Care At Koke Mill.

The provider's business location address is:

3132 OLD JACKSONVILLE RD
SUITE 110
SPRINGFIELD, IL
ZIP 62704-400
Phone: (217) 862-0062
Fax: (217) 862-0064

The provider's authorized official is William T Kendrick .
The authorized official title is Director and has the following contact phone number (217) 757-7493.

The CLIA number assigned to this NPI record is 14D0949277 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/10/2006 and was last updated on 6/16/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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