1811085293 NPI number — DR. TERRY MICHAEL BROWN DO

Table of content: DR. TERRY MICHAEL BROWN DO (NPI 1811085293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811085293 NPI number — DR. TERRY MICHAEL BROWN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
TERRY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1811085293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1433
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHYSBORO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62966-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-993-0086
Provider Business Mailing Address Fax Number:
215-895-3005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8305 EXPRESS DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62959-7771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-993-0086
Provider Business Practice Location Address Fax Number:
618-993-0088
Provider Enumeration Date:
10/10/2006

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: 2084S0012X , with the licence number:  14699 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: DO-264 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 028735 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 29462 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 036109663 , 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: P00118900 . This is a "RAILROAD MEDICARE- PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0723320 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3932015 . This is a "BLUECROSS BLUESHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 208084 . This is a "MEDICARE- GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DF5180 . This is a "RAILROAD MEDICARE- GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036109663 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 088817 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 660328 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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