Provider Demographics
NPI:1861677015
Name:MARSEILLES FAMILY HEALTH CENTER, S.C.
Entity Type:Organization
Organization Name:MARSEILLES FAMILY HEALTH CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:BECK
Authorized Official - Last Name:JAKUPCAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-795-2171
Mailing Address - Street 1:151 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-1484
Mailing Address - Country:US
Mailing Address - Phone:815-795-2171
Mailing Address - Fax:815-795-2397
Practice Address - Street 1:151 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1484
Practice Address - Country:US
Practice Address - Phone:815-795-2171
Practice Address - Fax:815-795-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1518953520OtherPROVIDER NPI FOR INDIVIDU
C46041Medicare PIN