Provider Demographics
NPI:1093412686
Name:MJM FAMILY MEDICINE SC
Entity Type:Organization
Organization Name:MJM FAMILY MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-339-3469
Mailing Address - Street 1:900 MAIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5022
Mailing Address - Country:US
Mailing Address - Phone:309-672-4470
Mailing Address - Fax:309-672-4471
Practice Address - Street 1:900 MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5022
Practice Address - Country:US
Practice Address - Phone:309-672-4470
Practice Address - Fax:309-672-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty