| Mackenzie A Heywood, | |
|
3132 Old Jacksonville Rd Ste 200, Springfield, IL 62704-7401 | |
| (217) 862-0800 | |
| (217) 862-0871 |
| Full Name | Mackenzie A Heywood |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 3132 Old Jacksonville Rd Ste 200, Springfield, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194352559 | NPI | - | NPPES |
| 036167992 | Other | IL | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | D0097004 (Maryland) | Secondary |
| 208000000X | Pediatrics | 036.167992 (Illinois) | Primary |
| Entity Name | Memorial Physician Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174877930 PECOS PAC ID: 9032005681 Enrollment ID: O20040223000454 |
| Mailing Address | Practice Location Address |
|---|---|
| Mackenzie A Heywood, 3132 Old Jacksonville Rd Ste 200, Springfield, IL 62704-7401 Ph: (217) 862-0800 | Mackenzie A Heywood, 3132 Old Jacksonville Rd Ste 200, Springfield, IL 62704-7401 Ph: (217) 862-0800 |
Stephanie E. Wojtowicz, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-787-9424 |
Claudine Gillison, Pediatrics Medicare: Medicare Enrolled Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-528-7541 |
Gopinathan Gangadharan Nambiar, Pediatrics Medicare: Medicare Enrolled Practice Location: 2901 Old Jacksonville Rd, Springfield, IL 62704 Phone: 217-698-9722 Fax: 217-391-0392 |
Dr. Susan M. Soler, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-787-9424 |
Dr. Kimberly Nichole Powell, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 415 N 9th St, Suite 4w16, Springfield, IL 62702 Phone: 217-545-8000 Fax: 217-757-6654 |
Jessica N Mistretta, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 400 N 9th St, Springfield, IL 62702 Phone: 217-545-8000 Fax: 217-545-2303 |
John Padanilam, Pediatrics Medicare: Medicare Enrolled Practice Location: 400 N 9th St # 4a, Springfield, IL 62702 Phone: 217-545-8000 |