Mitchell, Jerry E
Mitchell, Jerry E is an individual health care provider with primary practice located at 3315 N Seminary St , Galesburg IL 61401-1251. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Mitchell, Jerry E can be contacted via phone (309) 344-1000.Contact Information
Primary practice address
3315 N Seminary St
Galesburg IL 61401-1251
Phone: (309) 344-1000
Fax: (309) 344-1054
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | Illinois |
Profile Details
| NPI number | 1679674402 |
|---|---|
| LBN Legal business name | Mitchell, Jerry E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 26th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679674402 | NPPES |
| Other | 10621858 | CAQH | |
| Other | 4022647 | CAQH | |
| Other | 364271985-38 | CAQH | |
| Other | 4815127 | CAQH |
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