1629490628 NPI number — JOHN W. NEWLIN, M.D., LLC

Table of content: (NPI 1629490628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629490628 NPI number — JOHN W. NEWLIN, M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN W. NEWLIN, M.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1629490628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 W HAY ST
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62526-4167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-872-8100
Provider Business Mailing Address Fax Number:
217-872-8101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 W HAY ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526-4167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-872-8100
Provider Business Practice Location Address Fax Number:
217-872-8101
Provider Enumeration Date:
01/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NEWLIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
WESLEY
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
217-872-8100

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036074839 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004400 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005800283 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 110203310 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036074839 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122478 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195549 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".




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