Provider Demographics
NPI:1326348152
Name:NOLEN CLINIC LTD.
Entity Type:Organization
Organization Name:NOLEN CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-937-4164
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-0008
Mailing Address - Country:US
Mailing Address - Phone:618-937-4164
Mailing Address - Fax:618-932-3203
Practice Address - Street 1:107 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2907
Practice Address - Country:US
Practice Address - Phone:618-937-4164
Practice Address - Fax:618-932-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003613261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT35489Medicare UPIN