Provider Demographics
NPI:1104831627
Name:ARCHEY, JO ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:
Last Name:ARCHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-366-8107
Mailing Address - Fax:217-366-6106
Practice Address - Street 1:209 W BORMAN DR
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3632
Practice Address - Country:US
Practice Address - Phone:217-892-9671
Practice Address - Fax:217-892-2530
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110125 1Medicaid
ILP00129449OtherRAILROAD MEDICARE
IL279500OtherMEDICARE GROUP
ILI01535Medicare UPIN
IL279500OtherMEDICARE GROUP
ILK08421Medicare PIN