Provider Demographics
NPI:1942219837
Name:HEALTHCARE NETWORK ASSOCIATES
Entity Type:Organization
Organization Name:HEALTHCARE NETWORK ASSOCIATES
Other - Org Name:MENARD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:217-757-7493
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-757-7491
Mailing Address - Fax:217-757-2021
Practice Address - Street 1:1 CENTRE DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-9467
Practice Address - Country:US
Practice Address - Phone:217-632-7761
Practice Address - Fax:217-632-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350674Medicare ID - Type Unspecified