Provider Demographics
NPI:1740544436
Name:NEWERA HEALTHCARE, LLC
Entity type:Organization
Organization Name:NEWERA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:618-751-9045
Mailing Address - Street 1:2733 KOKOPELLI DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5213
Mailing Address - Country:US
Mailing Address - Phone:618-751-9045
Mailing Address - Fax:
Practice Address - Street 1:2733 KOKOPELLI DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5213
Practice Address - Country:US
Practice Address - Phone:618-751-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067057207Q00000X
IL209000459363LF0000X
IL209007626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC47483Medicare UPIN
IL2668005Medicare UPIN
IL2045460003Medicare UPIN