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MED PLUS PHYSICAL MEDICINE LLC NPI 1730467135


NPI Information

NPI: 1730467135
Provider Name: MED PLUS PHYSICAL MEDICINE LLC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
20 PROFESSIONAL PARK DR
SUITE A
MARYVILLE, IL
ZIP 62062
Phone: (618) 288-5044
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MED PLUS PHYSICAL MEDICINE LLC is a general practice in Maryville, IL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee MED PLUS PHYSICAL MEDICINE LLC NPI is 1730467135. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

20 PROFESSIONAL PARK DR
SUITE A
MARYVILLE, IL
ZIP 62062-830
Phone: (618) 288-5044
Fax: (618) 288-9472

The provider's authorized official is Matthew W Bretz .
The authorized official title is Owner and has the following contact phone number (618) 594-3671.

The enumeration date for this NPI number is 8/2/2011 and was last updated on 8/2/2011.


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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral Practice248000193ILLINOISYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1IL4910MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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