1982613345 NPI number — MARILEE KAE HARVEY CRAMER NP

Table of content: MARILEE KAE HARVEY CRAMER NP (NPI 1982613345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982613345 NPI number — MARILEE KAE HARVEY CRAMER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARVEY CRAMER
Provider First Name:
MARILEE
Provider Middle Name:
KAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982613345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATHAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62629-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-670-2424
Provider Business Mailing Address Fax Number:
217-670-2809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 OLD JACKSONVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62704-7437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-698-9722
Provider Business Practice Location Address Fax Number:
217-391-0392
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  041206732 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 041206732 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: 209002225 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08421024 . This is a "BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 133586700 . This is a "ACS-OWCP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 14D0949277 . This is a "CLIA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 041206732 . This is a "IL STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 500012379 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CD7143 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 064699 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 323742 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 020057300 . This is a "BLACK LUNG" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6394P . This is a "CATERPILLAR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 209002225 . This is a "IL ADVANCED PRAC NURS LIC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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