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FAMILY MEDICINE OF MCLEANSBORO LLC
NPI 1801920889
Nurse Practitioner - Family in Mcleansboro, IL

Active since March 14, 2007
208 S WASHINGTON ST, MCLEANSBORO, IL 62859(618) 643-2835(618) 643-2891 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Family Medicine Of Mcleansboro Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAMILY MEDICINE OF MCLEANSBORO LLC (NPI 1801920889) is a healthcare organization registered as a family in Mcleansboro, Illinois and active in the NPI registry since March 2007. The organization lists Michael S Davenport, Manager, as its authorized official.

NPPES Registry Identity

NPI1801920889
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameFAMILY MEDICINE OF MCLEANSBORO LLC
Location Address208 S WASHINGTON STMcleansboro, IL 62859-1139
Mailing Address208 South Washington StreetMcleansboro, IL 62859 · (618) 643-2835 · Fax (618) 643-2891
Phone(618) 643-2835
Fax(618) 643-2891
Organization SubpartNo
Authorized OfficialMichael S DavenportManager · (618) 927-8714
Enumeration DateMarch 14, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1801920889 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
208 S WASHINGTON ST, Mcleansboro, IL 62859
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELYSSA GAYLE WIGGINS FNP
Nurse Practitioner (Family)
208 S WASHINGTON ST
MC LEANSBORO, IL 62859
Hamilton County (618) 643-2835
HAMILTON MEMORIAL HOSPITAL DISTRICT
Clinic/Center (Rural Health)
208 S WASHINGTON ST
MC LEANSBORO, IL 62859
Hamilton County (618) 643-2835

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Family Medicine Of Mcleansboro LLC's NPI number?

The NPI number for Family Medicine Of Mcleansboro LLC is 1801920889. It was assigned to this organization in the NPPES registry on March 14, 2007.

Where is Family Medicine Of Mcleansboro LLC located?

Family Medicine Of Mcleansboro LLC is located at 208 S Washington St, Mcleansboro, IL 62859. The listed phone number is (618) 643-2835.

What is Family Medicine Of Mcleansboro LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Family Medicine Of Mcleansboro LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.