Provider Demographics
NPI:1629490628
Name:JOHN W. NEWLIN, M.D., LLC
Entity Type:Organization
Organization Name:JOHN W. NEWLIN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:NEWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-872-8100
Mailing Address - Street 1:302 W HAY ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4167
Mailing Address - Country:US
Mailing Address - Phone:217-872-8100
Mailing Address - Fax:217-872-8101
Practice Address - Street 1:302 W HAY ST
Practice Address - Street 2:SUITE 130
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4167
Practice Address - Country:US
Practice Address - Phone:217-872-8100
Practice Address - Fax:217-872-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
004400OtherHEALTH ALLIANCE
IL0005800283OtherBCBS
IL110203310OtherRAILROAD MEDICARE
IL036074839Medicaid
122478OtherHEALTHLINK
195549OtherCOVENTRY
IL036074839Medicaid