DECATUR FAMILY MEDICAL GROUP INC NPI 1619243987

NPI Information

NPI: 1619243987
Provider Name: DECATUR FAMILY MEDICAL GROUP INC

Doing Business As: CORNERSTONE FAMILY MEDICAL CENTER

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
440 SUNSET CT STE C
MT ZION, IL
ZIP 62549
Phone: (217) 864-1236
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DECATUR FAMILY MEDICAL GROUP INC is a primary care clinic center in Mt Zion, IL. DECATUR FAMILY MEDICAL GROUP INC NPI is 1619243987. The provider is registered as an organization entity type.
The provider Is Doing Business As Cornerstone Family Medical Center.

The provider's business location address is:

440 SUNSET CT STE C
MT ZION, IL
ZIP 62549-556
Phone: (217) 864-1236
Fax: (217) 864-1470

The provider's authorized official is David Carl Gregory .
The authorized official title is Ceo and has the following contact phone number (217) 422-3702.

The enumeration date for this NPI number is 3/30/2012 and was last updated on 7/21/2022.

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
1	261QP2300X	Clinic/Center	Primary Care	036103155	ILLINOIS	Yes

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
1	1871599522	OTHER		PROVIDER'S NPI

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

NPI Synchronization or Removal

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