Provider Demographics
NPI:1871180109
Name:TILTON FAMILY MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:TILTON FAMILY MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIMEHORN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:217-703-1359
Mailing Address - Street 1:100 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:IL
Mailing Address - Zip Code:61833-7423
Mailing Address - Country:US
Mailing Address - Phone:217-703-1359
Mailing Address - Fax:
Practice Address - Street 1:100 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:IL
Practice Address - Zip Code:61833-7423
Practice Address - Country:US
Practice Address - Phone:217-703-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMS2122125OtherDEA
IL209.008876OtherLICENSE NUMBER