Provider Demographics
NPI:1336328186
Name:DR. M.T.JOSEPH M.D.LTD
Entity Type:Organization
Organization Name:DR. M.T.JOSEPH M.D.LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MDFACC
Authorized Official - Phone:618-993-8282
Mailing Address - Street 1:1009 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1841
Mailing Address - Country:US
Mailing Address - Phone:618-993-8282
Mailing Address - Fax:618-997-3630
Practice Address - Street 1:1009 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1841
Practice Address - Country:US
Practice Address - Phone:618-993-8282
Practice Address - Fax:618-997-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD10778Medicare UPIN
IL298800Medicare PIN