Provider Demographics
NPI:1376656827
Name:WEGMANN, JOEY ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:ALAN
Last Name:WEGMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N. HENDERSON
Mailing Address - Street 2:OSF GALESBURG CLINIC PROMPT CARE
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-343-1000
Mailing Address - Fax:309-343-5207
Practice Address - Street 1:302 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5116
Practice Address - Country:US
Practice Address - Phone:618-242-4750
Practice Address - Fax:618-242-7674
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000851363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085000851Medicaid
IL719926OtherHEALTHLINK
IL719926OtherHEALTHLINK
IL085000851Medicaid