Provider Demographics
NPI:1275310252
Name:TWILIGHT MED LLC
Entity Type:Organization
Organization Name:TWILIGHT MED LLC
Other - Org Name:TWILIGHT MED PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:217-855-5662
Mailing Address - Street 1:2980 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4279
Mailing Address - Country:US
Mailing Address - Phone:217-855-4969
Mailing Address - Fax:
Practice Address - Street 1:2980 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4279
Practice Address - Country:US
Practice Address - Phone:217-855-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty